Life with Diabetes

I never thought I would consider waking up in the morning to be a victory. I never thought I would be concerned, daily, with a fear of losing my eyesight, my limbs, or my kidneys. I never thought I would be thankful when I go to bed for having lived another day. I never thought I would be diabetic.
   But, now I am. On April 21, 2009, while preparing for my first trip to Europe — alone — I learned that I had developed the disease. While I expected the trip to Europe to help me grow, the diagnosis made me grow in an evening.

In the United States alone, over 18 million people (or 8.3% of the population of the United States) suffer from diabetes, according to the American Diabetes Association (ADA). In addition to those 18 million, another 79 million people suffer from “pre-diabetes”. Pre-diabetes is a condition in which a patient’s blood sugar is elevated, but not enough to warrant treatment with medicine. Countless others suffer from diabetes and are unaware — an estimate set forth by the ADA is 6 million Americans.

Before being diagnosed as diabetic, I was not unaccustomed to the disease. In 2005, I watched and assisted as Dad suffered through a heart attack and surgery, most likely induced by his undiagnosed diabetes. I learned through Dad what diabetes was and how to live with it. Mom began reading books on diabetes, and she and I would discuss her findings. I learned how diabetes affected the body, and how one could fight back against type-2 diabetes.
   Having Dad as a fellow diabetic should have made me more aware of the symptoms of diabetes. In fact, I heightened my sensitivity of the symptoms, for a while. However, when these symptoms began manifesting themselves in me, I had lost my sensitivity.

Diabetes occurs when a person’s body fails to handle carbohydrates in food properly. In a normal, non-diabetic body, when food is digested, carbohydrates are released into the blood stream as sugar. The blood then carries this sugar to cells that use a hormone, produced by the pancreas (located behind the stomach), to absorb it. This helps the cells to work, repair themselves, and otherwise keep your body alive. Insulin is what helps the cells absorb sugar; it is released by the body when your body realizes you need more insulin.
   However, in a diabetic’s body, the pancreas either fails to produce the insulin, or does not make enough of it. What this means, then, is the cells are unable to absorb the sugar in the blood, which stays trapped. This sugar floating around in the blood can cause problems, including kidney failure, heart attacks, strokes, and even blindness.

Because of the speed at which type-1 diabetes develops, many young patients of diabetes are informed that they have diabetes after being rushed to the hospital. Other patients get rushed to the hospital after being diagnosed in the doctor’s office. I am extremely blessed that I was not informed of the disease in the hospital, but because I could not imagine how that would affect a person, I decided to get a personal testimony.
   I spoke with Mrs. Jan Case, whose son, Mark, has been diabetic for over fifteen years. Mrs. Case stated that her son was fourteen when he was diagnosed with type-1 diabetes. Despite showing all the usual symptoms of diabetes, the family’s general practicing doctor diagnosed him as having “just allergies”. She also recounted a conversation that, had she known what she knows now, should have triggered her: “I was cooking dinner one night and Mark comes in and says, ‘I’m starvin’ can you hurry?’ I responded, ‘You’re not starving to death.’”
   Mrs. Case said that her son’s diagnosis of diabetes came after he was not feeling well. “It was Easter weekend, Good Friday, and he should go out of town, but he was not feeling right,” Mrs. Case began. “I went to the store and got a testing kit. He was clear off the color scale. I called the clinic, they said they couldn’t get him in until Monday — because of the holiday.” Eventually, a nurse got on the phone and told Mrs. Case to take her son to the Emergency Room. When Mark arrived at the emergency room, “his sugar was 990 [milligrams per deciliter].” “It was a shock to the whole family,” Mrs. Case informed me.
   For the next week, Mark was hospitalized. “He was still four- to five-hundred often while in the Emergency Room,” Mrs. Case recalled. To make matters worse, the family had recently moved, and Mark was due to start at a new school.
   “Mark temporarily lost his vision while still in the ER,” Mrs. Case informed me. “By the time he started school, things were still blurry.” Mrs. Case admitted that she was scared to let go at first. The first place Mark went alone was to diabetes camp, “Camp John Wavel”.
   Mrs. Case said that a common theory of diabetes is that something could trigger it, such as a major disease (chicken pox, measles, etc.) or even something as routine as a common cold. However, she stated the only thing she can recall is “pneumonia, that’s the only serious thing.”

Diabetes has been called “the silent epidemic”. The disease can affect anybody, anywhere, for any reason. While the effects of diabetes on patients are a constant point of discussion when a person is diagnosed, what are the effects on the family?
   Mrs. Case explained her personal experience as the mother of a diabetic. She stated that she was devastated. She continually wondered, “what did I do wrong?” She worried that Mark’s sister would also be diagnosed with diabetes. She described the whole thing as a “feeling of helplessness”. She admitted that she would “stand in the shower and cry. As a mother, you want to make your children well.” She admitted that the best thing to do was to help to the best of her ability.
   She continued by saying that the whole family learns about diabetes. “It is amazing how much parents learn,” Mrs. Case said. She explained that the entire family began living healthier: “We played indoor basketball. We started eating healthier — it was good for everybody.”
   However, not everything was always good. Mrs. Case stated that Mark’s sister developed a real jealous streak. “She felt like she had a lack of attention,” Mrs. Case elaborated.

In December 2008, I began to show signs of diabetes. My clue should have been when I dropped a strand of Christmas lights on my foot and slightly cut it. This cut took too long to heal — longer than cuts had ever taken before. I began to fear I had diabetes then, but after two or three weeks when I thought the slowly healing cut looked more like a scar, I just ignored it.
   Another sign of diabetes, one of which I didn’t know at the time, was that I could not hold my liquor. I am not one who drinks daily, hardly monthly. I enjoy an occasional drink, but after having a glass of wine, I felt dizzy and nauseated and just thought I had grown intolerant of alcohol. It turns out that the alcohol spiked my blood sugar to a point where my body couldn’t handle it. Now, after drinking a few times in Europe, I know how alcohol affects me, and can only assume this dizziness was a clue.
   Finally, I was constantly hungry. I once ate five slices of pizza. Five slices, I am sure we’ve all done that. However, this was a pizza of which I can’t eat more than three slices, not even when I am “starving”. I chalked this up to having been outside sledding in the freshly fallen January snow, and not eating much all day. Yeah, right.

Diabetes is a chronic, life-long disease, like many well-known, well-researched diseases. Yet, unlike some others, diabetes does not need to be life threatening. If a patient ensures that he looks after his body, he should be able to live a very long productive life.
   A very comforting thought always enters my mind when I begin to worry about diabetes: my mother had a step-grandmother who was diabetic. She lived a healthy life into her 100s, taking multiple insulin shots every day. She found out when she was in her teens. And that was before the technology we have now!
   Further proof that it is possible to live a fulfilling life with diabetes is given through the lives of many famous people. It is possible to live a rewarding life and still manage your blood sugar. I am afraid that we forget to tell the type-1 diabetics that. So many resources are tailored to type-2 diabetics, that the younger patients get overlooked, and we do not get much information except for the bad news. Despite that, many people have gone on to do marvellous things with their lives.
   Such famous diabetics include Mary Tyler Moore, Jay Cutler, Bobby Clarke, and Charlie Kimball.
   Mary Tyler Moore is a very prominent figure, despite being diagnosed with type-1 diabetes. She has starred in sitcoms including The Dick Van Dyke Show and The Mary Tyler Moore Show. She has been a vocal activist for diabetes research and is the JDRF’s International Chairman.
   Bobby Clarke, OC, is a former professional hockey player, having spent much of his career in the National Hockey League (NHL) playing for the Philadelphia Flyers. Despite being diagnosed with diabetes when he was 12 or 13, he was a successful player, leading the Flyers to the Stanley Cup title twice, setting records, and being inducted into the Hockey Hall of Fame in 1987. He has served in managerial positions for several teams in the NHL.
   Jay Cutler is the current Quarterback of the Chicago Bears in the National Football League. Announcing on May 1, 2008 that he has the disease, Jay Cutler has been successful in recent seasons. He led the Chicago Bears to the conference championship game at the end of the 2010 season. He also is very active with diabetes outreach, donating to the ADA depending on his season statistics.
   Charlie Kimball is a rookie in the IZOD IndyCar Series, the premiere open-wheel racing series in the United States. Hospitalized during his 2007 season, Charlie returned to the track in 2008. Driving with a glucose meter in the car, he was successful in Europe before returning to the States and entering the Firestone IndyLights series in 2009. He is quite open about his affliction, with sponsorship from the company who manufactures the glucose meter in his car.

It took a mandatory doctor’s appointment before my study abroad trip to Austria for me to discover I was diabetic. Working around my school schedule, I went in for my appointment on a Friday. When I finished telling the doctor my symptoms, she immediately suspected diabetes. I was off to the lab for tests. Oh boy, diabetes! Taking insulin, I couldn’t handle that — I hate being a pin cushion; heck, I didn’t even like getting my blood drawn for the tests.
   That weekend, I prayed, fervently, every night. I asked God to please, please, not make me diabetic. While I did have sympathy for those who were, I never wanted to be among them. Prayer filled my head almost all day, every day. My possibility of being diabetic had made me remember only the bad things about diabetes.
   Mom and Dad learned about the diagnosis first, on the following Tuesday — April 21, 2009. My brother and I stayed at school late to take a Psychology test, so when we got home, we were greeted by two stuffed Easter bunnies on the dining room table, and Mom and Dad sitting in the dining room. I became concerned immediately, and said one final silent prayer. They told us to sit down because they had news.
   “The good news is that nobody is dying,” Dad started out. My heart sunk and I knew the diagnosis. Dad said some more, I don’t remember what, but it did end with, “you’re diabetic, Kyle.”
   I tried to fight it, and only half-heartedly argued with Mom and Dad. After Dad said it, I knew, I just didn’t want to admit it. I couldn’t handle it any more and spun around and ran off to my room, crying and yelling at God under my breath. I spent around ten minutes in my room crying alone, before Mom, Dad, and Corey came in. They brought my Easter bunny and tried to comfort me. I didn’t want to admit it at the time, but Mom and Dad were telling me the truth when they said I would be all right.

Dr. Amanda Gosch explained how blindness could result because of diabetes. Dr. Gosch is an Optometrist with Ossip Optometry in Plainfield, Indiana. According to Dr. Gosch, permanent vision loss is the most serious damage to a diabetic’s eyes. She stated that this occurs as a result of uncontrolled bleeding, which “can bring fluid into the eye — resulting in scarring”. The scarring is the reason the vision is lost.
   Dr. Gosch laid the process of vision loss as such: Diabetes can affect the small blood vessels. With the excess sugar floating in the blood stream, hemorrhages can occur. In other words, the vessels begin bleeding; much like when you cut yourself, and the blood comes out to create a scab. If the blood sugar is brought back under control, “the bleeding can resolve”. This uncontrolled bleeding can be seen by optometrists either through dilation or images of the interior of the eye.
   Dr Gosch stated, though, that if the bleeding is uncontrolled, i.e. the sugar levels remain high, the fluid enters the eye. What happens is the fluid wedges its way in between the layers of the eye, where it begins to cause scarring.
   According to Dr. Gosch, laser surgery can be performed to limit the amount the fluid can spread. However, continued elevated sugar levels can produce a loop sensation, and eventually, no amount of laser surgery can be performed to keep the scarring from blocking the retina. This is known as retinopathy.
   Dr. Gosch warned that since eye blood vessels and kidney blood vessels are very similar, eye damage could be a warning indicator of kidney failure.

With sugar levels being the cause of most of the complications, I have learned how important it is to test the amount of sugar in the blood. By testing, I can ensure that I am feeling my best each hour of the day, every day. I also like to test my blood sugar level every time I don’t quite feel right. I check my blood sugar at least twice daily — once when I wake up and once before I go to bed — and most days, I check it four times.
   So, what is the procedure like? It usually takes an average of five minutes to check my sugar, but I feel the time spent is worth it. I start out by washing my hands thoroughly with soap and warm water. I then dry my hands, ensuring that they are completely dry — damp hands, soap, and other liquids can affect the number.
   Once I have finished cleaning my hands, I prepare my testing area. If I am testing at home, I just grab a tissue and my meter and sit down at the table; out of the house, I position a paper towel on the washroom sink, so I can put my meter on the paper towel. At home, I take out my log and make notes of what I ate and the activities I did between my last check and the current check. I also make a note of the time; out of the house, I let my meter’s memory hold the number and the time, and I take notes when I get to a location more conducive to writing.
   Once I have taken my notes, I take my meter out and put in a test strip — this is where the blood goes. I grab my lancing device, put in a “lancet”, which is a piece of plastic surrounding a metal wire, and load it. I wipe my finger once more to ensure it is completely clean and ready. Then, I hold the lancing device to my finger and press the button.
   After cutting the skin, I squeeze the blood out of my finger so that it makes a small drop. This is then fed into the test strip. The meter takes care of the calculating and testing.
   While waiting on my result, I grab the tissue (or paper towel if out of the house) and temporarily put pressure on the finger to stop the bleeding. I then record the number the meter states, take the test strip out — putting it in the tissue/paper towel — and remove the lancet from the lancing device. At home, I dispose of the test strip and lancet properly; out of the house, I place them in a marked Ziplock bag to take them home and dispose them there. I pack up my kit, and put it away.
   Finally, I wash my hands again, to ensure the small, pin-sized cut will no longer bleed. I then return to my daily life.
   While all diabetics know what the prick of testing feels like, those who are not diabetic and have never had a glucose test will not. The feeling that I get is very similar to when I poke myself with a pin or a staple. It is uncomfortable, at first, but quickly forgotten.

After hearing the news of my diagnosis, I felt terrible. I have not been the healthiest person. I had my tonsils removed when I was five, I had a heart operation when I was in fifth grade, and now this: diabetes. I couldn’t wrap my head around how I could be so unlucky.
   The three weeks following my diagnosis are a blur. All I know is I learned, quickly, how to deal with my sugar levels. In two weeks, I had my sugar down from the 300+ mg/dl readings before eating to the recommended range of 130 mg/dl or less before eating. I learned how to watch what I eat, and how to deal with high blood sugar levels.
   The one thing I could not handle was telling people. The remainder of the semester I told two people: a friend from German class, who I trust; and my German professor, with whom I felt a special connection. I also told my Psychology professor, because I knew I needed to talk through my emotions with somebody qualified. I have struggled with telling people until recently; now I have become quite vocal about it and how I can live a “normal” life.
   My six weeks alone in Europe were a learning experience. I grew wiser in understanding my body, and became more comfortable with injecting my once daily insulin shot. My first two weeks, however, I had a lot of difficulty. I ate less than I did in the States, and exercised more. Several times I woke up shaking from low blood sugar numbers. I finally decided “enough is enough” and had Mom and Dad call the doctor to figure out what was going on. I was injecting too much insulin, in effect overdosing. When I got that worked out, I reduced the amount of insulin and had a much better experience.
   I returned from Europe feeling very comfortable with myself, and understanding my body. I knew that I was far from knowing everything, but I was more comfortable with the disease, and I knew that I could still live. I learned that I could live alone, and be independent like any normal college kid.

The American Diabetes Association, in its Compete Guide to Diabetes, recommends that diabetics get their eyes checked once yearly. Why go once a year? It is recommended to go once a year because of the bleeding that Dr. Gosch explained earlier. This bleeding causes problems, and by going once yearly, it is a good, proactive response to diabetes. One which may save a diabetic’s eyesight, or even his life.
   In addition to the yearly exam, dilation of the eye is recommended by the ADA — and required by some insurance companies (mine for example). What benefit could dilation have, especially when companies are developing optical imaging technologies? Dr Gosch explained, “With dilation, we can see in 3D. Using depth perception, we can see if edema [excess fluid] has occurred.” This is in comparison with only 2D using the images. She admitted that using dilation is more subjective than using imaging technologies that also check for excess fluid, as Ossip’s equipment does. Dr. Gosch told me her personal opinion: “I prefer to use both. If I see something on the OptoMap [the model of equipment used by Ossip], then I like to use dilation.”

In addition to being proactive with eye exams, the ADA recommends visiting your general practitioner at least once every three months. This allows your doctor to take the A1C test, which tracks average blood glucose over the preceding three months. The ADA recommends having a blood pressure check every visit, in addition to a foot check.
   Why is blood pressure so important? Well, for one thing it is a problem, even in non-diabetics. But, what exactly does blood pressure do, especially when coupled with diabetes? Dr. Gosch stated, “Together they are an exacerbation of the problem. Blood pressure affects the blood vessels; diabetes affects the blood vessels. Together, it’s not good.”
   Why is a foot check important? By checking the feet, the doctor can ensure that there are no cuts, sores, or infections that could present a problem to a diabetic. Because diabetics heal slowly, the cuts and sores could become infected. Additionally, the foot exam will ensure that no signs of neuropathy (death of the nerves) are present.

Finally, the ADA recommends that diabetics visit their dentist every six months. Even though this is no more than the recommended timeframe for non-diabetics, it is still important, as issues can occur in the mouth because of diabetes. The ADA’s Complete Guide to Diabetes explains: “Bacteria, especially those that thrive in the mouth, love sweets. And when you have high glucose levels, your saliva makes your mouth an inviting home for the bacteria that cause gum infections and disease. Having diabetes further complicates matters because it’s harder for your body to fight off infections once they start.”
   Proper brushing, including getting up next to the gums, will help to reduce the possibility for issues. Flossing helps, too, because it gets the bacteria from between the teeth.

Facing my first full semester since discovering I was diabetic filled me with trepidation. For the first time ever, I would be on campus for twelve hours on Wednesdays, and that thought concerned me. I would be eating lunch and dinner on campus — could I keep my sugar under control?
   After being quite successful the first few weeks, I began to be really comfortable. I also became close friends with a classmate in my night class, and told her about my condition and she kept an eye on me. My first late-nighter taught me that staying up late (until 1 or 2 in the morning) without recovering the sleep was a bad idea, and I have never intentionally stayed up so late that I could not get at least 7 hours of sleep.
   From there, my school life has not been an issue. I was able to keep my sugar under control at school and that was before I checked it more than twice. Now, I am sure to check my sugar at least twice daily, and to check at school.

The ADA’s Complete Guide to Diabetes states that most diabetics will go through emotional stages, either when they find out their diagnosis, or as they go about their lives. Denial, depression, and anger are all normal reactions to the diagnosis, as well as common even long after the diagnosis. Additionally, changes in blood sugar levels can cause mood swings.
   According to Mrs. Case, Mark was ashamed of telling people he had diabetes. He also went through, and occasionally still goes through, periods of denial, and questioning, i.e. “why me?” Mrs. Case confirmed that with diabetes, mood swings are common.
   In my case, as stated earlier, I was also very ashamed of having diabetes. I kept my diagnosis to myself, and only told a few people. But I have learned the importance of letting people know.
   As time has gone on, I have begun to feel much more confident in myself, even though I have diabetes. Sometimes, I get depressed because of all the talk about complications, or because I work very hard, but am having difficulty with keeping my sugar under control.
   I can also generalize my blood sugar level through my emotions, although I do prefer to confirm the suspicion with testing. I tend to be more easily upset when my blood sugar is higher; I get more depressed and argumentative, too. I find it hard to think rationally and I get very nit-picky. I also want to sleep.
   When my blood sugar is low, I tend to be more spacey and lack concentration. I have a hard time understanding conversations, and I begin to shake. I am also very cool and calm. If I am thinking, I tend to be more rational, but if I am not thinking, I make really stupid decisions.

Today, my life is not dictated by my diabetes. I live and enjoy life, and am incredibly active. I consider myself a person who happens to have diabetes, not a diabetic person. I try to exercise daily, be it playing basketball, lifting weights, or just taking a walk on campus. I can still eat the things I enjoy, and I have learned how to live in moderation. Living in moderation is the key.
   Does that mean I don’t make mistakes? No, absolutely not. Diabetes is too complicated to not do that. Do I learn from those mistakes? I try. I keep detailed notes, so I can know exactly how everything affects my body. I guess I am doing something correctly: in two years, I have not had any problems; I don’t suffer from neuropathy nor retinopathy; and I am still taking only one insulin shot daily1. In fact, I have only missed one shot, and that was one of my first days in Europe, when, exhausted, I was afraid that I would injure myself.
   I am not going to brag. I know that it could all turn at any moment. So, every morning before I do anything else, I thank God for my life and for my perfectly healthy body. Every night, I thank God for another day. I realize now that I am not cursed, and I am not unlucky; I am quite blessed, actually. God may have given me a terrible life-long disease, but He also gave me a voice. In a way I have been given a gift, I can help to inform people about this terrible disease and help to raise funding for a cure.
   I never thought I would write an article about diabetes. I never thought I would be diabetic. And I certainly never thought I would call it a blessing.

Author’s Note 1: Upon further research and personal experience, the amount of insulin shots needed by a diabetic is not an accurate indicator of how-well-controlled the disease is. After changing doctors and speaking with that then-doctor (I have since changed again because I moved away from the referenced doctor), I learned that insulin is produced by the body every time blood sugar is raised (as was noted in the article) and the best course of action is to simulate that with the diabetic patient, which means taking a dosage of rapid-acting insulin with every meal, in addition to continuing the once-daily slow-acting insulin shot I had been taking. Since following this advice, my disease is now even better controlled than it was when I only took one shot daily.

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