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Doctors, Doctors Everywhere — and We Need Them
August 20, 2013
Now that I’m pretty much recovered from my hospital ordeal (I still have some lingering problems getting onto the scooter from my desk chair), it’s time to continue filling out my doctor dance card.
Most importantly, I need to reschedule my ophthalmologist appointment. I have two tiny little pinpoints of retinopathy — one in each eye — that don’t need treatment and I don’t want them to get any worse. If they do anyway, it’s best to take care of the situation early.
My dentist just retired, so I need to make an appointment with my new one, as soon as I figure out who that will be.
And, thanks to my hospital admitting diagnosis of respiratory failure, I’ve added a pulmonologist to my long list of docs.
It’s bad when you have a doctor for every part of your body…including your breath.
Generally speaking, we don’t go to all of those doctors because of any problems. We go to prevent problems or, if problems are beginning, to keep them from progressing (or, at least, to slow the progression down). If, for example, retinopathy is taken care of early, you’re a lot less likely to go blind later.
What’s behind all of those diabetic complications “they” scare you with? High blood glucose. That is, consistently high blood glucose, as would be seen by a high HbA1c test. (As Diabetes Burnout author and psychologist William Polonsky has said, “well-controlled diabetes is the leading cause of…nothing.”)
But how can extra sugar in your bloodstream cause any problems? Nobody ever tells us. Kind of like being told to “check your feet every day.” For what? What do I do if I find it?
Have you ever made syrup from water and sugar? It gets a bit thick, right? That’s what happens when your blood has too much glucose — or sugar — in it. In fact, I recall a past president of the American Association of Clinical Endocrinologists telling me about a man he saw whose blood glucose was so high, “the blood looked like syrup.”
My friend Karen, who is a CDE, passed along some information from the American Diabetes Association (ADA) that explained how high blood glucose can affect your blood vessels and, consequently, lead to diabetic complications. I always like to know why I’m supposed to do certain things so, using the ADA information as reference, I pass the following on to you:
Too much glucose in the blood makes the volume larger and miniscule blood vessels, part of the body’s microvascular system, just can’t handle that. So, it tends to lead to weak spots and ballooning out of the walls of tiny blood vessels, such as those in your eyes. Sometimes the thicker blood can block the tiny vessels completely, cutting off the blood supply to the retina. To lessen your chance of vision loss, keep your blood glucose in normal range as much as possible, your blood pressure in target range, and have a dilated eye exam at least once a year.
Did you know your kidneys can take care of things until only 10% are functional? This, too, is a microvascular problem. In this case, the small blood vessels thicken and just can’t filter properly any more. Components you need, such as protein, are spilled into the urine and washed away. Waste products you don’t need — think creatinine and urea — go into the blood, where they build up. Kidney function is checked via urine and blood tests. Your doctor should be monitoring your kidney function. If laboratory results show a decline in function, you should be referred to a nephrologist, a doctor who specializes in kidneys. According to what I’ve heard from people now on dialysis, a nephrologist should at least be able to slow down the progression to end-stage kidney disease.
Problems with the heart, brain, limbs, and nerves begin with fat deposits in the large blood vessels. Cholesterol and triglycerides are the fats and they’re deposited on the walls of the large blood vessels. I believe most of us know that causes narrowing of the vessels, but did you know it also leads to less elasticity? And one more thing: High blood glucose causes an increase in triglycerides. Here’s what can happen when the large vessels get clogged and stiff:
• When not enough blood gets to the heart or to sections of the heart via the coronary arteries, you can have a heart attack.
• The same thing with cerebral arteries brings the possibility of a stroke.
• Multiple problems can occur in the general circulation, especially the large vessels that lead to legs and feet. How does calf pain, ulcers (an open wound), and delayed healing of injuries strike you?
None of those strike me as being a lot of fun.
How does high blood glucose affect your nerves? Nobody is quite sure, but it decreases conduction of impulses and leaves your nerve endings damaged. The ADA says there are “other disturbances” too, but doesn’t explain what those are. Damage to peripheral nerves can affect your legs, feet, arms, and hands. Symptoms include increased sensitivity along with numbness or tingling, pain and burning, decreased sensation and, sometimes, muscle weakness.
I remember my Type 2 granny propping up the covers over her feet at night because she couldn’t stand for anything to touch them. She didn’t like wrinkles in her sheets, either. And, when she was in the hospital for an ulcer on her bottom, she begged the doctor to cut off her toes. I didn’t understand at the time.
The ADA didn’t go into this — and not many people do — but running consistently high blood glucose can also affect the autonomic (or automatic) nerves. Those are the ones that operate in the background and are responsible for things like heart rhythm, breathing, perspiration, digestion, and more. A late friend of mine had heart attacks she didn’t know about: She couldn’t feel them. Another friend gets her nutrition through a tube because her stomach doesn’t work.
The good thing about nerve damage is that, if you get your diabetes under control, you can decrease the symptoms.
Next week, I’ll tell you about what your doctor should be doing and how often. (As you may recall, this all started because my husband’s doctor wasn’t doing what he should.)
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