Diabetes Self-Management Blog

During my visit to the endocrinologist last Thursday, I got my "official" weigh-in. While I’ve been checking my weight-loss efforts on my home scales, this time it was on the scales that recorded my starting weight.

Yes, I have lost weight: 15 pounds. Five more pounds and I can read that book I got for my 20-pound reward. Thirty-five more pounds and I can book a cruise through the Panama Canal. Heck, maybe by the time I’ve lost 35 more pounds, I’ll even have the money to pay for the cruise!

The results of my efforts to lower my HbA1c, however, were not as positive: It’s only down two tenths of a point. At least it didn’t go up this time.

On the other hand, my lab results were all good. The ones I had done, that is. Since it’s a fasting test and my appointment was early in the morning, I was going to skip breakfast and have blood drawn for lipids when I got to the clinic. However, I needed to put a new cannula in and accidentally told my insulin pump to “fill tubing” instead of “fill cannula.” I pumped in eight units of insulin before I realized what happened and could stop delivery. So I had to eat something. Having a hypoglycemic incident while zipping along on the interstate would not have been a good thing.

***

I frequently contend that Type 2 diabetes, which has insulin resistance as a primary component, comes first and contributes to weight gain. While I was searching for something else, I came across the following from C. Ronald Kahn, M.D., president of the Joslin Diabetes Center, which was published in the June-July 2005 issue of a Brigham and Women’s Hospital newsletter:

“My research focuses on type 2 diabetes and aspects of insulin resistance… This is because insulin resistance is central to the pathophysiology of so many disorders, including obesity, the metabolic syndrome, hyperlipidemias, hypertension, accelerated atherosclerosis. It’s also linked to other medical problems like non-alcoholic fatty liver disease, PCO disease, and even neurodegenerative diseases like Alzheimer’s disease. Insulin resistance syndrome is a collection of related diseases, of which diabetes is the most obvious metabolic disorder and obesity probably second.”

I thought I knew what he was saying, but double-checked with my friend Ann Williams, R.N., Ph.D., C.D.E., who also has Type 2 diabetes (and sometimes writes for Diabetes Self-Management).

“What Dr. Kahn is saying,” she wrote, “is basically that the insulin resistance comes first. Obesity and diabetes, and all those other conditions he mentions, follow from the insulin resistance.

“I myself have thought this for a long time, because I saw it happen to me. I became suddenly and dramatically insulin resistant in my 30s, during a time of extreme psychological stress. One of the many bad effects of this was that I got very, very hungry, with a hunger that could not be satisfied. Well, when the body is not letting the cells receive glucose, the cells are glucose-deprived, and you feel hungry all the time, even right after eating plenty of food. In any case, I was not overweight until all of this happened to me… I was eating huge amounts of food, because of having huge hunger. I was so occupied with the situation causing stress that I did not have enough energy to fight the hunger. The result was that I gained enough pounds over about four years to make me very overweight. I had insulin resistance and the genetics for Type 2 diabetes first. High blood glucose and diagnosis of Type 2 diabetes followed.”

***

What I was actually looking for was the following, which I found while looking for something else. (See what you can come up with when you surf?)

Diabetes is a serious health problem, is an epidemic, and a study should be done to confirm the hypothesis, one person told the U.S. Public Health Service. And a 10-year study did prove the hypothesis.

That’s a recent finding, right? Wrong, Sweet Pea. It was Joslin Diabetes Center founder Dr. Elliott P. Joslin…in the mid-1940s.

Ahhhh. The more things change…

Perhaps that epidemic has been going on for at least 70 years, exacerbated not only by today’s more convenient lifestyles, but also by changes in the criteria for diagnosis (hey—if you lower the numbers, more people are going to qualify) and an increase in awareness.

***

There I was, driving down the road, when my continuous glucose monitor (CGM) buzzed, telling me it needed to be calibrated. Luckily, a friend who also has diabetes was riding with me. All I had to do to hand over my monitoring kit and CGM and hold out my hand and she did the finger sticks and calibration.

One more reason to count other people with diabetes among your friends.

And, by the way, my husband could have done it, too. I let him practice diabetes-related tasks on me—like insert an infusion set, check my blood glucose, or give me an injection—in case I’m incapacitated at some time and he has to take over. I also give him expired glucagon kits to practice with so he won’t become as panicky if he has to use one for real.

***

Remember that I was planning to take the train to Washington, D.C., in August? Well, that’s fallen by the rails. (Sorry.) It appears that, because I want to take a mobility scooter with me, Amtrak wants to charge me for a seat, but doesn’t want me to sit in it.

Apparently, their attorneys have decreed that people who take a wheelchair or a scooter on the train have to sit in said conveyance instead of having it stored while they sit in a nice, comfortable seat. If I had to sit on a scooter, my bum would be numb before the train got out of Chicago!

While Amtrak’s Web site says, in part, “If you choose to transfer to an accessible seat, you may stow your wheelchair nearby,” and while a scooter is smaller than the maximum dimensions given for a wheelchair, it’s a no-go.

While I was told I would get a refund for the ticket I bought, I haven’t seen anything of the sort on my credit card statement yet—and that was a week ago. They sure did charge my card fast enough.

Had I called Amtrak to book the trip instead of doing it online, I would have found out about the rule before buying tickets. However, the site says to book by phone if you have a disability and I don’t think I have one. Isn’t disabled if you can’t walk? I can walk—just not far—and can handle steps if there is a handrail.

Ah, well, back to airplanes. Airlines know how to handle scooters. I ride mine up to the plane, they take it away, store it during the flight, and bring it back to the door when the plane lands. Aside from their penchant for twisting the basket into an unrecognizable mass of metal mesh, it works out quite well.

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