Friday, May 01, 2015

Are Diabetes Complications Inevitable? Not necessarily...


This is a very personal post, reporting on my own recent reports on three aspects of my health: my eyes, my heart and my other affliction, leukaemia.

I am writing this partly to celebrate but also to motivate any newly diagnosed type 2 diabetics, shocked and scared, who have been warned by their doctors of the inevitability of their diabetes progressing to complications. I suppose some doctors feel they need to do that to scare new people into making lifestyle changes, but too often I find dire predictions of long term complications or heart attacks lead to loss of hope. That can lead to a 'why bother' mentality. 

Please, do not give up. I know managing type 2 diabetes can be bloody inconvenient. You will have to make some annoying changes to your life such as pricking holes in yourself, adding some activity to your day, forever watching what you eat and drink and possibly taking meds and insulin. 

Let me assure you: taking control of your blood glucose levels is worth the trouble. I am just one example of many I read on the better diabetes forums where pro-active type 2s are learning how to take control.

Possibly my continuing story will give you hope.

I was first diagnosed with leukaemia and type 2 diabetes in 2002 at the age of 55. I discovered early I could do nothing at all about the leukaemia; for that reason I concentrated on beating the diabetes. I was thirsty for knowledge. For the first couple of years I spent a lot of time learning from many wise people, mostly on usenet. Some were medical professionals but most were experienced diabetics. I learned something from all of them, even if the main thing I learned was how to tell good advice from bad because, unfortunately, a lot of it was bad. I still believe the best advice was Jennifer’s Test, Test, Test: “Use your body as a science experiment.” 

I tested and experimented to find what worked for me. On usenet over the next couple of years I gradually changed from reader and student to lay advisor, passing on information based on my experience. In 2004 I joined some online forums. In 2006 I started this blog. 

Eventually I wrote a book based on my experience to help any newly diagnosed people who might not be computer-savvy. Of course, as my suggestions for good type 2 management differ significantly from the mainstream there will always be critics. In part this is a response to the critics, describing the results of practising what I preached for the past decade.

Motivation

We each must find our own motivation for maintaining the discipline. For me, it is my sight. Since the day I first learned about the possible complications of diabetes my over-riding motivation has been my vision. I came to accept the possibility of death and I certainly don't want to lose limbs from neuropathy or kidneys from nephropathy, but the thought of living in darkness scared me silly. I have tremendous respect and admiration for vision-impaired people who successfully live with that daily. But I do not want to join them. I am a reader of books, an appreciator of beauty, a user of computers and above all I want to see my grand-daughter’s joy as she grows and learns.

The tests used by doctors to monitor our diabetes such as HbA1c, fasting blood glucose and post-prandial blood glucose are all important but they are really only surface indicators. I use those indicators to set my goals, but they don't directly alert me to dying nerves or optic cells. The acid test is whether complications eventually appear as the years pass. 

Limbs and Kidneys

So far neither blood tests nor physical symptoms, including filament tests by my podiatrist, have indicated any signs of neuropathy or nephropathy. I am hopeful that will continue.

Eyes

I had some good news last month. It is over thirteen years since diagnosis and I had not seen the ophthalmologist since 2010. I had a good report then after a scare in 2006 when he discovered minor scars from healed retinopathy. The scars had disappeared by then. This recent visit was almost identical to that 2010 consultation.

The waiting room was packed. After various eyesight checks on new strange machines by the assistant, then the anaesthetic drops, followed by the dilation drops, then another wait, then more tests on machines, I eventually saw the ophthalmologist. He did a very thorough inspection. He warned me that as I age (I am now 68) I may start developing cataracts but at this stage I had no problems apart from inevitably getting older. I wanted reassurance so I asked specifically about retinopathy, macular degeneration and glaucoma as there is some family history of the latter. He re-inspected carefully. He expressed no concern and no evidence of past damage. Then he complimented me on my "superb diabetes control with respect to eye health". I cannot express in the written word how happy that made me feel. Is there a cloud ten above cloud nine? At his request we then spent a few minutes of his valuable time discussing the Test, Review, Adjust technique.

OK, that covers the ‘opathies. None at all. But there is another lurking danger for diabetics: the heart. 

Heart.

I dropped Lipitor ten years ago; the more I read about statins the less I am convinced of my need for one. My doctor has been polite and patient with me when I have consistently refused a statin for the past nine years despite high cholesterol by official standards. My HDL and triglycerides are fine but my LDL is very high. He suggests that may be because of my low-blood-glucose-spike (which many interpret as low-carb) way of eating. He strongly recommended I have a stress echocardiography accompanied by ultrasound of my heart, mainly to reassure him I am not going to keel over tomorrow. I had those tests last September. First, the gooey preparation and the ultrasound, twisting to awkward positions. Uncomfortable but not painful. Then walking faster and faster on the treadmill, with wires hanging off me, having problems reaching the heart rate he wanted. Eventually we got there. As I cooled down it was fascinating seeing the movies of my own heart pumping away on the playback screen of the ultrasound. 

The cardiologist was very thorough and pleased with the results. It seems my heart and vascular system are in fine shape. No problems at all. I will continue to refuse the statin and eat low-carb, moderate fat, for good blood glucose levels. I no longer care at all what my LDL is.

Leukaemia
 
Finally, although I would like to, I cannot forget my Chronic Lymphocytic Leukaemia sitting in the background like the Sword of Damocles. I make no claims about my diet or lifestyle for that. I’m just lucky I suppose. All of my indicators have improved over the years until almost all are in normal range. I still have hypogammaglobulinemia associated with the CLL but one of the indicators for that, IgM, has crept back into normal range. The IgG and IgA are still low, but oddly I don’t seem to be catching anything despite wandering the far corners of the world since diagnosis. I saw the haematologist quarterly at first, then every four months, then every six, now I waste his time annually.

The haematologist, ophthalmologist, podiatrist (who displays my book at reception and has sold several copies) and my General Practitioner tell me to keep doing what I’m doing. 

That sounds like good advice to me. I will heed it.

Cheers, Alan
Everything in Moderation - Except Laughter

Saturday, September 20, 2014

Catering For Different Tastes When Cooking

I see variations on this question asked many times on the various forums I am on:

Being head cook and bottle washer, I have a question. Having D, I need certain foods, my son has become a meat and potatoes guy, my wife eats most anything, except a variety of veggies. I do not want to have to cook 3 separate plates to satisfy all. How do you cater to each taste, or do you? Is there a happy middle?

The same problem occurs for the person who is not the cook but does not want to offend the person who is. This may help those people: Cooking as a Survival Skill. But I realise that is not possible or practical for some.

Here is my own method for dealing with the situation. I am the cook in our household, mostly just for the two of us. Mum is invited for dinner a couple of times a week.

It is important to keep in mind that I am the only person with diabetes. Although I may believe others would benefit from my way of eating it is not my role or place to force them to eat as I do. We each have our own food likes, dislikes, aversions or allergies.

I am diabetic and careful about carbohydrates but otherwise omnivorous. My wife has a very limited menu, by choice, and a long list of foods she detests. For example, she will not eat fish or seafood, eggs, steak, many vegetables, milk, the list goes on. Her likes are basically meat (other than steak), starchy vegetables, peas, tomatoes and silverbeet (chard). My mother is omnivorous but, like most people, has a few foods she prefers to avoid.

If I restricted myself to cooking only the foods we all like my menu would become very limited and boring. I also actively seek to include fish and a wide range of seasonal vegetables in my diet. Therefore, at most meals for the two of us I cook three types of foods. Those I can eat, those my wife will eat, and those we both eat. The other night was a typical example. In the steamer I had potato and pumpkin (winter squash) simmering in the bottom section with silverbeet, carrots, cabbage and broccoli in the top. I cooked two loin lamb chops under the grill (broiler) for her and when they were almost cooked I seared and fried a fillet of Atlantic Salmon in a small skillet for myself.

At the table I put the salmon on my plate, the lamb chops on hers, and all the vegetables on a platter in the middle. We served ourselves from the platter. She had most of the potato and silverbeet; I took most of the rest.

When my mother or other people are dining with us I use the same method. I find out whether anyone has specific protein likes or dislikes and serve that appropriately, letting them select their own vegetables and starches from the centre of the table. For major feasts such as Christmas dinner everything is served buffet-style for diners to select as they wish.

It really isn't as difficult as it sounds, with a small amount of extra thought and effort keeping everyone at the table happy and healthy.

Tuesday, July 22, 2014

It Must Be OK - It's Sugar-Free! Wrong!

A very brief post to emphasise an important point.

When we as diabetics are choosing foods for the menu or checking the ingredients of a recipe, sugar should be treated as just another carbohydrate. It is more concentrated than most carbs but my meter has repeatedly shown me it is the total carbs that count, not just the sugar content, when I test my blood glucose after eating.

Food products which are marketed as sugar-free are very rarely carbohydrate-free. In fact, more often than not they have just as many carbs as the sugared versions. I encountered a classic example of this a couple of days ago when I saw a large display in my local Aldi store promoting 'healthy' sugar-free products. 

These are photos of just some of the products. Sorry about the smart-phone quality of the pics; the carb counts are clear enough. I'll let them prove my point.

99.5% Sugar-free Shortbread = 67.9% carbohydrates


99.5% Sugar-free Chocolate Digestive Biscuits = 61.3% carbohydrates


99.5% Sugar-free Wafer Biscuits = 62.4% carbohydrates


99.5% No Added Sugar Dark Chocolate = 57% carbohydrates


The piece-de-resistance. Sugar-free Mixed Fruit Drops:

  

I could not believe this one when I turned the can over. There was no added sugar, so it must be healthier than other fruit drops...yeah, right. 

It is 93% carbohydrates.

  

Always read those labels, folks.

Cheers, Alan, T2, Australia.
Everything in Moderation - Except Laughter