Read an Excerpt
TYPE 2A Book of Support for Type 2 Diabetics
By Miryam Ehrlich Williamson
Walker & CompanyCopyright © 2003 Miryam Ehrlich Williamson
All right reserved.
Chapter OneGETTING THE WORD
Sit with a group of diabetics for a while, and you hear a range of diagnosis stories. Some people saw the doctor because they recognized diabetes's symptoms and expected to hear what they ultimately were told. Others went in for an entirely different reason and were shocked to learn what was really wrong. For some, the news came in the course of a routine physical examination; for others, it followed a crisis. Some have seen family members struggle with-or ignore-the disease and then fall prey themselves to the genetic tendency that often makes diabetes a family affair. Some have heard that obesity can lead to diabetes and were not in the least surprised when it caught up with them. To others, the slim ones who follow healthy eating guidelines and are physically active, the diagnosis may have come as a bitter shock.
The magazine articles and Internet Web pages that tell you to watch out for diabetes symptoms tell only part of the story. To be sure, there is a constellation of symptoms-what you experience and report to the doctor-that almost always means diabetes. Most common among them are a thirst that no amount of fluids will quench and, consequently, the almostconstant need to urinate. Another telling symptom if feeling tired most of the time-because of the inefficient conversion of food to energy. The doctor who hears these complaints should immediately think of diabetes and confirm it by looking for its primary sign: a high level of glucose (sugar) in the blood, sometimes called hyperglycemia. Hyper- means "too much," -glyc- refers to glucose, and -emia refers to the blood.
The Cecil Textbook of Medicine, a standard medical reference book, says a blood glucose reading higher than 200 mg/dl (milligrams of glucose per two-tenths of a pint of blood), taken without regard to the time of the most recent meal, is sufficient for a diabetes diagnosis, and that further tests only delay the start of treatment. Some physicians want to see the result of a fasting blood sugar test, the blood drawn at least twelve hours after the last time you had anything to eat, before giving a definitive diagnosis. A fasting blood sugar reading higher than 120 (some experts say 115) is reason to suspect diabetes. One over 140 makes it a sure thing.
Sometimes people can go to the doctor practically wearing a sign that says "I have diabetes" and come away without a diagnosis. Fifty-two-year-old Gary thinks he weighed more than 400 pounds when he went for a routine physical and complained of thirst, frequent urination, and lack of energy. He's not sure of his weight because the doctor's scale stopped at 350 pounds. Gary quotes his doctor as saying, "`Gee, your sugar level is getting up there.' I had never heard of a sugar level," he says. "My doctor said, `You've got to watch your sugars.' I didn't know what he was talking about, so I started reading package labels, but I didn't know what was high and what was low. So I tried to avoid anything that had sugar in it, which is nearly impossible."
Over the next three months, Gary saw his doctor repeatedly-complaining mainly of overwhelming fatigue-but received no instructions on how to control his blood sugar until he landed in the hospital for five days. That was four years ago. Today Gary is hundreds of pounds lighter and keeps his condition in cheek. As a frequent speaker at meetings of diabetes support groups, he inspires others with his success story.
For Vernon, a forty-eight-year-old software engineer, diagnosis came as a doctor's offhand remark. Vernon had been troubled on and off for several years with an irregular heartbeat. Feeling particularly poorly, he went to his doctor, who told him, "Your diabetes is acting up." "I'm not diabetic," Vernon replied. "You are now," his doctor said.
When Greg, then fifty-one, showed up at his doctor's office complaining of unbearable thirst, a nearly constant urge to urinate, and fatigue, his doctor almost certainly knew what the diagnosis would be. I was "half dead, too tired to move," Greg recalls. The doctor did a blood glucose test on the spot. The test showed a blood sugar level of 670, more than three times the diagnostic level. Greg's doctor admitted him to the hospital immediately.
A very dry mouth, but not what she identified as thirst, troubled Helen, a fifty-five-year-old freelance writer. She was losing weight at a rapid pace and had recurring vaginal yeast infections. "I mentioned these symptoms individually to my internist over a period of a few months, but as isolated symptoms," she says. Helen didn't fit the classic diabetes profile. She wasn't overweight, and the disease didn't show up in her family history. She diagnosed herself using a guide to health that she had at home and trusted. "It apparently didn't occur to my doctor to put the symptoms together, but it occurred to me, and I told him so." The doctor doubted she had diabetes but tested her anyway. Her blood glucose level turned out to be 440.
Serena also diagnosed herself. At the time, she was a forty-four-year-old homemaker living in British Columbia, Canada. "[I was feeling] "dizzy, sick to my stomach, thirsty all the time, and running to the bathroom," she recalls. She used a friend's glucose monitor, then consulted her doctor. In a series of tests, Serena's blood glucose readings ranged from 13.5 to 18.9. Canadians do not report blood glucose levels the same way that Americans do. According to the Canadian Diabetes Association, multiplying a given Canadian measurement by 18.2 gives you the U.S. equivalent, which means that Serena's blood sugar levels were between 246 and 344 at the time she was diagnosed.
Some medicines, whether prescription or over the counter, can mask diabetes's symptoms, delaying the diagnosis and giving the disease more of a chance to do damage. Roberta, a forty-nine-year-old retired nurse, thought her continual need to urinate was caused by the diuretic she was taking to fight tissue swelling (a little-recognized sign of insulin resistance, a leading cause of Type 2 diabetes). Alana, a thirty-seven-year-old emergency medical technician, blamed her constant thirst on allergies, and the antihistamines and decongestants she took to relieve the symptoms. She thought thirst was a family characteristic. Older relatives told her, "We're a dry family. We just always stay dried out," she says. Roberta and Alana are Native Americans, members of a group with a particularly high incidence of Type 2 diabetes.
Blurry vision is another symptom that often accompanies diabetes. When Marcia realized that cleaning her glasses wasn't going to help her see any better, the fifty-one-year-old administrative secretary checked with her doctor. Her blood glucose reading was 181. Her doctor didn't wait for a second test to start treating her for diabetes.
Robert, an electronics technician, was fifty-seven when he suddenly started experiencing the classic nonstop thirst, an incessant urge to urinate, and an unexplained weight loss. But he knew nothing about diabetes and didn't recognize the danger signs. So he was stunned when he went in for his yearly physical and received the news that his blood sugar level was 350 and that he had diabetes.
For some, the symptoms that precede diagnosis are more dramatic than thirst, frequent urination, fatigue, and weight loss. At fifty-four, Raymond was starting a second career as a psychotherapist when he went to a neurologist with neck pain. "I was paralyzed with pain for about a month. It took me nearly two hours to complete a thirty-minute drive to work because every few minutes I'd have to pull over and stop to stretch and deal with the pain," he remembers. The neurologist wrote in his report that diabetes-induced nerve damage could be the cause of Raymond's pain. When Raymond had a fasting blood sugar test, the reading was 360. After his diagnosis, Raymond learned that depression, which he had been fighting for years, can often precede diabetes by as much as ten years. There's no way to tell whether the stress that accompanies depression precipitates the diabetes, or vice versa. Raymond says, "It is the chicken-and-egg thing. No one is willing to say that if you get depressed, it will cause diabetes-or if you have diabetes, it will cause depression. But the two frequently go hand in hand."
Paul, a fifty-four-year-old postal service worker, saw his doctor after getting dizzy and falling off his motorcycle. He was knocked unconscious but didn't break any bones. It wasn't Paul's first bout with dizziness, but it was the most life-threatening. Suspecting reactive hypoglycemia, a condition that often precedes diabetes, the doctor did a finger stick, tested Paul's blood glucose level, and immediately gave him an insulin shot. "I asked why, and he said I was diabetic. My blood sugar was over 450," he says, adding, "I'd had lots of thirst, but I wasn't big on sweets, so diabetes never entered my mind. I didn't know then that, for me, a pile of rice is just as bad as a piece of cake."
Charles, a forty-seven-year-old telecommunications analyst, went to a walk-in clinic for treatment of a gastrointestinal virus. The doctor told him his blood sugar level was 350. "It was a total surprise," Charles says. Later, he realized he'd been having classic diabetic symptoms for about five years. "I hadn't considered it strange that my feet were turning brown," he says wryly.
Thad, a fifty-three-year-old insurance claims examiner, didn't fit the diabetes pattern at all. Thad is the second oldest in a family of eight siblings. His brother Greg, fifteen months older than Thad, was diagnosed with Type 2 diabetes at forty-two. Heavier and less physically active, Greg didn't pay much attention to his health while Thad, who wasn't overweight, ran twenty miles a week and lifted weights. After twelve years of uncontrolled diabetes, Greg died unexpectedly. "He went to sleep and just didn't wake up," Thad says. "His heart had just given out. No pain for him, anyway."
Even though he was aware of the relationship between lifestyle choices and diabetes, his closeness to his brother, both emotionally and in terms of age, led Thad to call his family doctor. "I was feeling great and didn't have any symptoms," Thad recalls. The doctor did a complete physical checkup. Readings above 180 on two successive blood sugar tests led the doctor to diagnose diabetes. Disbelieving, Thad nevertheless took the prescribed medicine, which reduced the amount of glucose his liver produced, and gave up sweets. "Although I had a sweet tooth, I could give up sweets because I figured they would be poison to me," he says. He thought the doctor was being an alarmist, and that if he eliminated sugar from his diet he'd be home free. He wasn't. After a dinner of meat loaf and mashed potatoes, his glucose meter reading was 222-higher than the readings that led to his diagnosis. "That scared me. I decided maybe the doctor was right," he says.
REACTIONS TO THE NEWS
Just as they vary in symptoms and the circumstances under which they are diagnosed, people with Type 2 diabetes differ widely in the way they react to the news. Many are understandably shocked or dismayed at the news that they have an incurable illness. Some feel overwhelmed; others take a fatalistic attitude, often because the disease runs in their family and they've been expecting it to strike them. Often, those who have lost a loved one to diabetes are terrified, fearing a similar fate. Individual reactions can run the gamut from anger, resentment, and disbelief to resignation, determination, and even relief.
Even though she'd been expecting it, the emotional impact of the words you have diabetes came as a shock to Elaine, fifty-two, who used to work in international sales and marketing. It was four months since her mother had died of kidney failure resulting from poorly controlled diabetes ("Her choice," Elaine says.) Images of her mother, nearly blind and with poor circulation in her legs, came to her mind when she heard her own diagnosis. "I was pretty scared, even though realistically I knew that did not have to be my fate," Elaine says.
Shortly after Rose's mother died of complications of uncontrolled diabetes, this forty-four-year-old registered nurse used her mother's glucose monitor to test her own blood. "Diabetes is everywhere in my family, so I would have been more than aware of any excessive thirst or urination. There was nothing like that, no sores that would not heal, none of the normal warning signs," she says. "I would say that fatigue and a never-ending slight headache had been my only symptoms. Since my mom had died unexpectedly only a month before, I thought the fatigue was part of the grieving process." Rose's blood glucose level was 225. "I woke up my husband and tested his blood sugar. It was 96. I cried for an hour," she recalls. "It was only after my sugars were under control, three months later, that I realized how badly I had been feeling."
A family history of diabetes didn't help Roberta, the retired nurse, accept the news that her blood sugar level was over 300. The doctor told her to make an appointment for another test in two weeks. "I panicked," she says. "I felt like I'd just heard a death sentence. Both grandparents on my father's side died from diabetes. Aunts and uncles have passed away also. I'd seen them undergo amputations and watched most of them go blind." In the first hours after she received her diagnosis, Roberta says she saw her life draining away. Today, though, she says, "I am not going down without a fight."
Like Roberta, Grace, a forty-nine-year-old accounting clerk, was terrified when she was rushed to the hospital, too weak to stand up, and learned her blood glucose level was 575. She had never heard of diabetes before her diagnosis. She had no idea what the word meant, nor did she know that her African-American heredity put her at higher risk for the disease. Even the classic warning signs of excessive thirst, frequent urination, and sudden weight loss-all of which she had experienced-meant nothing to her. She decided to prepare herself to die.
Vernon greeted his diagnosis with "shock, disbelief, dismay, and denial." He says it took him several years to accept that he had diabetes and get on with learning to control it.
Thad, whose brother had recently died of diabetes complications, was resentful. "I felt that it wasn't fair," he says, "the way someone who had never smoked but got lung cancer anyway might feel. I had a supervisor at the time who was shorter than I was and weighed 320 pounds, but he didn't have diabetes.
Excerpted from TYPE 2 by Miryam Ehrlich Williamson Copyright © 2003 by Miryam Ehrlich Williamson
Excerpted by permission. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.