By Jan Chait | February 27, 2007 10:42 am
Sometimes I envy people with Type 1 diabetes. They know very quickly that they have diabetes. They know they have the “real” kind of diabetes. They get to take insulin right away. They know what blood glucose levels to target.
Although I should say here that that’s what I imagine happens. I don’t know, never having been Type 1. Maybe the information out there is as bad for them as it is for us Type 2’s.
Let’s take my points in order, beginning with knowing that you have diabetes. You see, many Type 2’s find out they have diabetes after the heart attack. After the stroke. After an amputation. After they have diabetes-related vision problems.
Recently, I ran across some data that gave the percentage of people with Type 2 who get the complication before the diagnosis, but forgot to remember where it was and couldn’t find it when I looked. It was fairly high, as I recall.
One person I know had surgery for a trigger finger (more common in people with diabetes) and has had the skin condition necrobiosis lipoidica diabeticorum, or NLD (also more common in people with diabetes), for years. The warning signs were there, but nobody checked. Not until fasting blood glucose levels were well above diagnosis levels did the doctor allow that maybe they should “keep an eye on it.” What was he waiting for? The heart attack?
A post from a member of a mailing list I’m on mentioned that his Type 2 diabetes was diagnosed when one of his limbs was amputated.
So we have people who go undiagnosed for years and, by the time they learn they have diabetes, it’s too late to prevent or delay complications because they’re already there.
The reason I mentioned the “real” kind of diabetes up there is because I don’t think that some doctors believe Type 2 is the real thing. And if they do, they certainly don’t pass that information along to their patients.
An ophthalmologist I know once told me he’s seen people with diabetic retinopathy (eye disease) and, after checking them to find very high blood glucose levels, has asked whether they’ve ever been told they have diabetes. “Oh, yeah,” he reports hearing. “But I took some drugs and it went away.”
I even know of one person whose doctor told him “You don’t have diabetes anymore” when the diabetes drugs he was taking helped bring his blood glucose down. So he stopped taking the meds. Guess what? His numbers went back up. He still sees that doctor—but he’s also going to an endocrinologist for his diabetes care.
For a long time, I was berated for being “noncompliant” when what I needed was insulin. Insulin is so wonderfully adjustable; it’s what your body makes (or is supposed to) and, aside from knocking your on your tush once in awhile, doesn’t have a lot of the side effects that oral medicines have.
A woman who was in a mindfulness meditation class I once took complained one day that she was gaining weight and couldn’t figure out why. Turns out her doctor had prescribed a diabetes drug that can cause up to 20 pounds of weight gain (and then berated her because she was gaining weight). Not only did he fail to advise her about the side effect, but he denied it when she confronted him. So I gave her a copy of the insert to show him. (Gotta read those inserts.)
Are the medicines that stimulate insulin production speeding up beta-cell burnout? I don’t know. I’m not sure anybody does and have never run across a study that compares people who take that class of drugs with those who don’t or who take insulin. Given the chance of having my Type 2 diabetes progress even faster than it would otherwise, I’ll take insulin—which could possibly have the benefit of preserving beta-cell function.
Back in the day, before somebody finally sent me for diabetes education, my doctor told me to check my blood glucose, but didn’t tell me what to look for. So I checked…once in awhile. It usually hung in the 300’s, so I figured I was at least consistent. I had no idea that it was too high until a friend who is a lab technician told me what “normal” was. Oops!
Does that happen to Type 1’s as well? I tend to think not—or, at least, not as often.
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