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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Comments
  1. Dear Jan.

    Your hypothesis that stress causes insulin resistance, subsequent massive weight gain, and finally diabetes would sure fit my life history. Is the American Dream and associated life style toxic to most people? Should we have adopted the attitude that it was not necessary to become a millionnaire to be happy? Should they teach stress relaxation techniques in school and save billions in health care cost?

    Posted by CalgaryDiabetic |
  2. Omigosh! That’s exactly what happened to me! I was under tremendous physical and emotional stress and blamed myself for the weight gain because I was starving all the time, eating too much and drinking too much soda. By the time all was said and done, I had fibromyalgia and was overweight. After open heart surgery and a second auto accident, I was diagnosed with prediabetes, then Type 2. I worked hard and lost a lot of weight, but physical problems and stress led me back to eating like I was starving again. I don’t know how to break the cycle, because the weight exacerbates the physical symptoms that lead right back to weight gain….

    Posted by delebra |
  3. Great post, Jan. IMO, stress is the #1 cause of insulin resistance. And insulin resistance is the cause of Type 2 diabetes, overweight, and the whole metabolic syndrome.
    It’s part of the physiology of the stress response. Under stress, all the glucose is supposed to go to the cells that are used for running away or fighting (the “fight-or-flight response”). All the other cells become insulin resistant, so they won’t use the glucose your legs and arms need.

    That’s great for running away from a wild animal, but it doesn’t work at all for the stresses we face in our lives now, like the ones in your post. Stress wants us to run or fight, but we don’t. We can’t. That’s why physical inactivity is the #2 cause of insulin resistance. The two together are a deadly combination.

    I’ve written about this a lot. You can see a good article over at mendosa.com.

    Posted by David Spero RN |
  4. Dear Jan and David. This is capital insight. Maybe the best antidote is exercise and the more intensive or even better interesting would be great in fighting stress and thereby insulin resistance.

    Even low intensity activities like fishing could be good. There also you should do fly fishing that needs constant brain participation to cast properly and to set the hook when the fish bites rather than baiting a hook and then thinking about all your other problems.

    My favorite Female used to wake me up at 2.00 am to point out all of the inadequacies of our empire I told her to write everything down that it would still be perfectly true in the morning. I wonder if writing down all the problems and forgetting them for a while would be a good strategy. The American way of being proactive about everything immediately is extremely stressful.

    Most of my life and the more so since diabetes a good night sleep has eluded me. To fall asleep promptly it is desirable to have the blood sugar in the very low end of normal but if I do this 1 out of 2 times it will go too low.

    Posted by CalgaryDiabetic |
  5. I gained a lot of weight before I knew I was diabetic. I only found out because I had a cyst in my breast and even after treatment for it on 3 seperate occasions I was not healing. That Dr. requested I have a diabetes test. My primary Dr. didn’t believe I had it but ran the test any way. Much to his surprise I did have it. He told me if I lost weight it would go away. At the time I weighed 210. Then I had some mental issues and was placed on Neurotin, which my primary said would help with the tingling in my feet and legs. Well it didn’t help I just gained more weight. When I reached 285 my mother started to become scared and started riding me about my weight. Eventually I realized I wasn’t going to be a very good EMT if I didn’t do something. At the time I was in school for my EMT intermediate license. I was having to buy larger uniform pants, my shirts were getting to tight. So I decided to do something about it. Since then I have lost down to 209. My medication has been changed for unknown reasons and my sugar levels are higher than ever. I have set a goal to reach 200. Once I reach that I will set a new goal. I’m just frustrated that things are getting worse. I don’t know what to do. Why has it got worse since I have lost so much weight?

    Posted by emt diabetic |
  6. Jan are you still recovering from your knee replacement and if so how did it go. On the affects of stress I was told by a fellow type 1 diabetic that he was told by his PCP that his diabetes was caused by stress he was booted out of the military for his dx.

    Posted by Kimbo |
  7. Wow!. I think it is discrimination. They want you to sit on your scooter seat the whole time you are riding on Amtrak but want to charge you for the seat you are not sitting on. That does not make sense. I think they are double dipping. It would not surprise me if by doing that they are able to get double price for that seat because I am sure they while they will charge you for that seat and not let you use it, they will also charge some non-disabled person for that seat and thus make double income on that seat. I would report it. To me something stinks.

    Posted by deafmack |
  8. Hi EMT

    Have your told your health care provider that the new meds aren’t working as well as the old ones? It could be that the new meds aren’t targeting the right thing. Also, type 2 diabetes is progressive, meaning that the longer you have it, the more likely you are to need more and/or different medications to manage your blood glucose levels, or need to add insulin.

    If something isn’t working for me, I’ve learned to contact my doctor immediately rather than waiting until my next appointment.

    Jan

    Posted by Jan Chait |
  9. Kimbo, thanks for asking, but I haven’t had knee replacement surgery yet. While I had planned to last December, the surgeon’s scheduler left the practice and my file kind of fell into a black hole. In addition, the surgeon had some kind of family emergency and was out for 2 or 3 weeks. Maybe this December. (Since my husband teaches and my grandchildren are both in school, I have to plan around school holidays if I’m to have any help at home!) I know it’s summer - hubby is department chairman, so he has duties now, too.

    Now I just need to get over my dislike of pain and fear of infection.

    Thanks for asking.

    Jan

    Posted by Jan Chait |
  10. Hi,

    I tried to add image but I don’t know how to do this
    Can anyone be kind to tell me how?

    thanks a lot

    Posted by candihaze |
  11. Merry Christmas to all… and to all a good night.

    Posted by marthafines |

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