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| ISBN-13: | 9781462034581 |
|---|---|
| Publisher: | iUniverse, Incorporated |
| Publication date: | 08/12/2011 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 92 |
| File size: | 993 KB |
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AT THE PRECIPICE
My Three-Year Journey from Stroke to Good Health with Type 2 DiabetesBy Jim Snell
iUniverse, Inc.
Copyright © 2011 Jim SnellAll right reserved.
ISBN: 978-1-4620-3456-7
Chapter One
Introduction
The last few weeks have seen clear evidence of my last three-plus years, struggling to effect an incredible turnaround of my type 2 diabetes and get it under better control.
On Sunday, November 7, 2010, I ran a Bayer At Home A1CNOW test to evaluate my A1C number, which was an amazing 6.9 percent. According to the documentation in the kit, 6.9 is in the green zone called "in control." It was a remarkable improvement. A prior test done a year or so earlier had been horrific, with a reading of 13.3 percent. The A1C number is a measurement of the blood sugar glucose that has been picked up by the blood hemoglobin and provides a three-month history of the levels that one's blood has been at.
In October 2010, a lab test of my kidneys showed all good Numbers in range and spec, and their efficiency had changed direction and now were showing improvement. My eye doctor noticed that my retinas were no longer hemorrhaging and had shown extensive healing. My allergist confirmed that my lungs had been improving. He put me on his gas analyzer laboratory machine. In the past, I could barely blow 470 with the aid of Albuterol and Qvar inhalers. Now I could easily blow 520 or better without aid on the handheld volume check unit.
Finally, thanks to a twelve hundred-calorie diet, I have seen my weight drop dramatically—from a high of 330 pounds down to 280, and it is still dropping. Previously, I could not lose a pound, no matter what I did.
In January 2011, I obtained a Continuous Glucose Monitor System (CGMS) so I could conduct my readings without sticking my finger thirty-two times a day. One month later, I was walking faster and better and started having serious hypoglycemic moments that required me to reduce my medication that included needle insulin type and pills. The comments out there indicate one can gain tighter control of diabetes by using a CGMS. That has been my experience.
After a three-year-plus journey, starting with my stroke on December 2, 2007, and through four distinct phases of healing, I am now on the correct path, and my type 2 diabetes is under control. I had been detected as a type 2 diabetic in the 1980s and have been fighting that all the way through to today.
The first phase took a year; this was the recuperating from the stroke, dealing with the physical disabilities it caused, and fixing my broken binocular vision. My right side, including my right eye, and balance on that side, was affected.
The second phase lasted another year. I struggled with my diabetes, with horrendous blood glucose (BG) numbers and daily high numbers every morning, and excess water in my lower extremities and constant water weeping from both legs without a known cause. Extensive BG numbers were taken and logged by me, and I walked two miles per day every day and made my first attempts to eat a twelve hundred-calorie diet. I had a scrotum filled with fluid; it was like a large cannonball. I took diuretics to get the excess water out.
The third phase began when my doctors concluded that the "liver dawn effect" and "emergency glucose addition effect" were broken due to failed hormonal communications between the gut, pancreas, and liver, which resulted in massive glucose increases from the liver (278–380 units). Note: The liver dawn effect is the role played by your liver to add sugar to your body just before you wake up, so that you are prepared to start the day. As long as the signaling between your pancreas (which generates the insulin) and liver (which regulates the insulin present in the blood) is working, the liver will add the correct amount of glucose. If not, your system will get a full-pail load of glucose, as though it is preparing you for the French Foreign Legion starvation march across the Sahara.
An emergency liver glucose addition is commonly called a "liver dump." When the pancreas-liver signaling is working properly, this glucose addition by the liver is invisible and should not inflate your blood glucose through the roof (i.e., from 278–311 or higher).
If one does not eat or at those times when the gut has no glucose to add, the liver dump occurs. The liver's role is to provide glucose and keep one's brain and cells alive. When the gut is providing glucose, the liver is supposed to be in fasting phase. When the gut has no more glucose to provide, the liver is supposed to switch to its sugar-making mode and supply glucose from its emergency supply. Researchers suggest that in type 2 diabetes the liver is always in sugar-making mode and does not return to the fasting mode when it is supposed to.
Around May 2010, after I researched this issue online, my doctors agreed that I should take additional metformin pills—500 milligrams (mg) at 10:00 p.m. and 12:00 a.m.—to shut down the dawn effect from midnight till 5:30 a.m. In addition, I was to aggressively monitor my BG and prevent it from going below 100 and triggering an emergency liver dump–glucose add. I adjusted my low-glycemic diet to ensure I had sufficient carbohydrates, which would generate the necessary glucose to keep my body and its cells running. (The alternatives are to take glucose tablets or accept that one's liver will be forced to keep releasing extra glucose and hope it is a controlled release and not one that blasts your BG averages off the map.)
The last phase was the use of a Continuous Glucose Monitor System (CGMS), which was not expected to be difficult but was a key change due to the information I'd gained by actively monitoring my BG twenty-four hours a day, seven days a week. In this phase, there was a dramatic change in needle insulin type, a large reduction in the doses, and the removal of the insulin-activating drug Starlix. I saw quite a stable running of the body's BG, similar to what most folks have, where it is slowly changing like waves on a placid lake. My numbers had been all over the place for the previous thirty years.
Finally, I continued my multi-loop, quarter-mile walking program every day and added extra walks when the BG was 190 or higher.
The result is documented above: the November 7, 2010, A1C of 6.9. The stroke had caused the loss of my job; mechanical, perseverance, and optical deficiencies; and disabilities that prevented the tools of my profession. It took me three-plus years to clean up this mess and get back on track. As best as I can tell tell from all the discussion out there, this disease has common factors at the highest level, having to do with carbohydrate control, diet, and hearty exercise. The aging and degradation of the endocrine system affects everyone slightly differently and in many ways that makes everyone's case different and difficult to treat.
For clarity, it needs pointing out that type 1 diabetes is generally considered to be an insulin failure by the pancreas and immediate treatment is needle insulin. Type 2 is a catch-all including everyone who is not type 1 but has excess, poorly controlled glucose in their body for a host of reasons. This is not a full list, but many reasons include reduced insulin generation by the pancreas; reduced meal bolus by pancreas; reduced basal insulin by pancreas; excess glucose production by liver; too many carbohydrates in meals; insufficient exercise; insulin resistance; etc.
The other great difficulty in dealing with a debilitating, sneaky disease like type 2 diabetes is that it has so many symptoms, and pinpointing the fix is complex and time-consuming. Our medical system is better geared to solving "battlefield injuries" (e.g., to size up a patient in as little time as possible, get the—eureka!—best first guess, and send the patient home with pills and the doctor's orders).
It takes hours and extensive data for any experts assisting in your care to really help you. A three- to five-minute conversation in the office of a doctor pressured to see as many patients as possible in the shortest time interval will have poor success without your detailed help and involvement. You will need to learn about and investigate the disease and current thinking about its cure, preferably online. Online gives one faster and broader access to the latest medical reports, and many good websites specialize in diabetes care and diagnosis. You have to be prepared to monitor your disease and take blood glucose readings, control your carbohydrates, and maintain your diet and exercise routines. Only you can do that. When you do this, you will get the detailed knowledge and data your team of experts—doctor, dietitian, endocrinologist, and diabetes trainer, etc.—need to quickly and efficiently help you tie this monster down. This is also the key to maintaining good long-term health, vision, body, kidneys, limbs, and a healthy heart. Of course, your doctor will identify the medications you need for insulin generation as you age. All can be resolved with a viable plan and approach.
Another serious concern is that type 2 diabetes is constantly changing its spots; it can be affected by weather, disease, colds, emotions, and aging. One has to watch and be prepared for flexibility and adaption. Even I was shocked when, after I completed the first draft of this book in November 2010, I went out and got a continuous glucose monitor and found that my body—through exercise and diet control—had changed. I needed to cut back on the oral insulin-generating drugs: instead of Starlix and the type of needle insulin called Humalog 75/25 at 23 units once a day in the morning, I started taking Humalog standard Lispro: four units in the morning, three at lunch, and three at dinner. I'd thought I would simply add better and more detailed data monitoring and roll along. Nope, after three years of working on this, the medicine changed for the better, but it took a lot of effort and patience to modify the program. My diet stayed the same and the hearty daily exercise continued unabated. If you get detected early enough, simple changes in diet and exercise can obviate the need for more aggressive management. If you are a strong, type A personality like I am, if your brain can ramp your heart rate up (160 to 190 on BP and rate of 120 or higher) when you are seriously thinking about an issue, or your natural fight-or flight-body response is set off and puts you on a DEFCON 5 level at the slightest of provocation—look out. Your blood glucose can change easily and quickly all over the map and will need very frequent and proactive monitoring.
You'll need to ask yourself three questions (discussed in detail later): Do you have a relatively stable BG level that slowly moves up and down in response to the food you've eaten?
Are your dawn effect and emergency liver glucose addition effects working reasonably well and not adding too much glucose? If not, your A1C number will be a clue. It will be above eight; mine was 13.3. Another clue will come from your blood-glucose meter readings, which could be as high as 150 at 3:00 a.m. and 200-plus by breakfast. Do you know your body's pill-ingestion times, the up-to-strength live time of the pill, and the body exit time? This is to ensure you have proper glucose as well as blood pressure all day long, until bedtime, when taking your recommended medicines, including heart pills, etc.
If the answers are stable glucose waveforms; no problem with the liver and its glucose functions and buffering; and your A1C is under control, you will find a lot of what follows to be interesting reading. You can drop blood testing to four to six strips a day, whatever your doctor recommends. (Anything you do to care for your diabetes must be reviewed and approved by your diabetes doctor, without exception.) Otherwise, you will want to read all chapters in this book thoroughly.
Finally, I leave you with this paraphrase from a TV commercial:
So you have been diagnosed with type 2 diabetes. You may choose to feel sorry for yourself. I hope you don't. I hope you find a good doctor and learn something about your body and diabetes. You'll need to go on a simple diet coupled with a good exercise program. Last, you'll need to learn how to use a blood-glucose meter, and test often.
Chapter Two
Phase 1: The Stroke
The first sign that something was deadly off track occurred in the wee hours of Sunday, December 2, 2007, as I crawled upstairs to the master bedroom. The next thing I remember was pain and a buzzing in my head, and I found myself on the floor. I crawled back to bed. I could not sit up or balance on my right. My face muscles were all sagging on the right side. I told my wife to call an ambulance. When I arrived at the St. John's Hospital emergency room, a doctor pestered me, asking when exactly this (i.e., the stroke) had happened. He needed to know so he could administer a special drug to clear the stroke. I honestly could not tell him. It turned out that my blood pressure was 210. I do not have the low number, as the higher number was the critical one in this case, and I might have bled to death on the operating table if I'd taken that drug.
The drug was not administered. Instead, I was given aspirin and kept in the emergency ward for two days for observation. Then I was moved to a regular hospital ward, where the doctors attempted to see if I could stand or walk. Fortunately, all seemed to be working—arms, hands, legs, toes, voice, eyes, brain, etc. The doctors did a CAT scan and MRI of my brain, upper chest, and heart. The CAT scan was clean; the MRI found a small clot issue in the area of my brain to do with right-side balance, movement, and eyesight. Nothing else seemed to be affected. In addition, an ultrasound of my heart and blood vessels found no evidence of any floating debris or minor clots. They checked my voice box, and no problems or paralysis were found.
However, my right-side balance was blown. A damaged nerve feeding my right eye meant that my binocular vision was not working; instead, I saw two independent images. There also was some paralysis on the right side. I could not detect differences in temperature with my left hand; when I picked up ice with my left hand, I couldn't feel the cold, which was dangerous. The right hand was good; touch and feel were functional. And I couldn't stand or walk.
I was sent over to a rehab group at the main branch of St. John's Hospital to relearn walking and standing as well as exercise the muscles that had been hit by the stroke. After thirty days in the hospital, I finally could walk with a walker and make it once around the nursing offices and rehab ward. I spent most of my time exercising and wheeling myself around in a wheelchair. I was not permitted to move on two feet without assistance and supervision.
Before I could be released and sent home, my bathroom had to be modified with support rods, a toilet chair, and a shower bench so I could move myself around. My son came from Bothell, Washington, and set up my bathroom. Because I could not walk up and down the stairs to the master bedroom, I had to have a bed set up downstairs in my small den. This bed did not have side safety rails like a hospital bed, so I would roll out onto the floor when asleep and hurt myself. (Now I sleep in a recliner that keeps me locked in.)
I spent most of my time using my walker and sleeping, trying to recover from stroke. Two or three hours of effort, and I was dead. Going back to work as a working/managing director of an electronics hardware engineering team designing ADSL2 and fiber to the home and new-age telephony gear based on Internet technology was out of the question.
My double vision drove me nuts, and regular optometrists were no help. After searching around I found a special group of optometrists who deal with strabismus eye problems and related deficiencies. As it turned out, they were a godsend and were able to isolate an eye-nerve paralysis that was affecting my vision, even though both eyes could move and track. They discovered that a prism of the correct strength could return some of my binocular vision. Reading books, newspaper columns, and fine-print documents is still very difficult and requires a large electronic magnifier and lamp of six diopter magnification. I used to love to read, and now it is an effort at all times.
(Continues...)
Excerpted from AT THE PRECIPICE by Jim Snell Copyright © 2011 by Jim Snell. Excerpted by permission of iUniverse, Inc.. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Contents
Preface....................viiChapter 1 Introduction....................1
Chapter 2 Phase 1: The Stroke....................7
Chapter 3 Phase 2: Working through the Diabetes and Other Problems....................10
Chapter 4 Phase 3: Solving the Issues....................12
Chapter 5 Continuous Glucose Monitor System (CGMS)....................16
Chapter 6 Pills....................18
Chapter 7 Medicine List and Recipe....................25
Chapter 8 Daily Routine: Summary and Overview....................35
Chapter 9 Diet and Other Rain Dances....................37
Chapter 10 Vitamins and Their Ilk....................43
Chapter 11 Booze and Having a Drink....................45
Chapter 12 Exercise....................47
Chapter 13 Heartaches and Tears....................50
Chapter 14 Insulin Loading and BG Numbers....................55
Chapter 15 A BG-testing Strategy....................61
Chapter 16 Conclusion....................80