Back from the doctor’s

Depressed again after a visit to the doctor for diabetic blood test results. My blood sugar was elevated enough so that we’ve decided that the medication I’ve been on (metformin) is not totally up to the job. I’ve started on a new drug (not glybenclamide, but rosiglitazone) today that will hopefully bring my blood sugar down to a reasonable level.

Diabetes (type II) is a progressive disease–as you get older, your pancreas produces less insulin and as this happens your blood sugar level goes up and your system needs more help in getting the insulin you are producing to be effective. Ultimately it’s likely that I’ll have to inject insulin morning and evening. This would be a timed-release variety according to the doctor and thus I wouldn’t have to inject before every meal (which is a good thing). (Type I is juvenile diabetes and stems from an immune reaction to pancreatic cells that leaves the diabetic with no insulin to speaik of.)

This is of course quite depressing. On the one hand, I should be glad that medicine has advanced as much as it has in the treatment of diabetes. It is still a serious chronic disease that only gets worse over the course of your life. However, the days when you automatically went blind and lost your feet and legs, one toe and limb at a time, are mostly gone nowadays. There are now three families of pills to take for Type II that are only slightly liver-toxic, and I’ve tolerated the metformin (which my doctor surprised me about today by telling me that there are lots of stomach side effects that people report with it–I’ve had none of these) very well. But, time is creeping up behind me now.

I’ve also never been a really good patient. The pediatrician I was taken to when young was a beast, really. He was of the “treat the boys rough” school and didn’t tolerate his patients’ reacting to pain or anticipating it. He was also one of those people who, when something slight was wrong with you, but you were also fat, said, “Right, you’ve got an ingrown toenail. Lose some weight.” As a child you don’t have a lot of choice in what you eat (or didn’t in the 1950’s) and my mother did, I think overfeed me when I was a young child. Finally, inoculations back then were done with reusable needles. These were quite thick and caused a lot of pain. The needles used today are mere pipettes compared to those sewer pipes they used to use. He was very severe with children who didn’t care to be inoculated with those huge needles.

This all adds up to a huge case of white coat syndrome. When I lived in the Bronx, I only visited the doctor when I had an infection (my cat bit and scratched my arm once and I got quite a nasty one) or when my bronchitis got too difficult to live with. I then went to a doctor in Manhattan later on who misdiagnosed my erection problem as low testosterone and said that I could have a testosterone level blood test if I wanted. I said no and thus both he and I ignored what I believe was the first troublesome symptom of the diabetes. Now of course Viagra is my friend. I have had diabetic retinopathy which was treated in one eye by laser surgery and this necessitates an annual visit to the retinal clinic at St. Thomas’s Hospital. The feeling in my feet isn’t so good and I must be careful how I walk and examine them for cuts and blisters. When the doctor tries to take my blood pressure now we have to chat for a while before she puts the cuff on me as the blood pressure is always high when I visit until I’ve started to chat and become comfortable.

When my diabetes was finally diagnosed, in 1992 in Chicago, it came from the optometrist noticing that I had the diabetic retinopathy). When I went to the GP, he put me on glybenclamide for the diabetes and hydrochlorothiazide for high blood pressure. When I moved to San Francisco in 1993, the GP there took one look at the list of pills I was taking and said, “You shouldn’t be taking the hydrochlorothiazide–that’s very bad for diabetics!” and I had to switch to various medications and patches, none of which helped the blood pressure.

Finally, losing weight helped me to get my blood pressure down. But I was put on another diuretic (Lasix) and had been taking ACE-inhibitors since 1993. These continue. So I now take:

  • metformin (x 2)
  • rosiglitazone (sounds like a drag name, doesn’t it? Preeeeesenting: Miss Rosie Glitterzone!)
  • Ramipril
  • frusemide (Lasix)
  • simvastatin
  • and, occasionally, sildenafil citrate (a.k.a. Viagra)

For those of you who are young, do yourselves a favour. Make sure that your diets are appropriate–low in fat, low in simple carbohydrates like sugar–and that you exercise regularly. While I still might have become diabetic eventually, such a diet would have helped me stave it off for longer. I believe I’ve had it for at least 16 years (judging from the impotence onset). I’d be joyful if I could last until 70 or 75. But had I exercised and been careful with what I was eating, I might not now have it at all.

But for me all that’s past now. I am determined to enjoy the time left to be and be as careful and cautious with my weight as possible. But, ultimately, we’ll all die and I know I’m not immortal. So all I can do is try to ensure that I take as good care of myself as I can.

Oh, and the packaging of all these pills is very wasteful, too. The new pills come in lots of 28 tablets, but the box is quite chunky. I managed to get 5 out of the 6 blister packs that came in the three boxes into one box. I realise they’re a bit safer than pillbottles, where the pharmacist has to count them out, but how wasteful is it when you have three boses and throw away two.

2 Responses to “Back from the doctor’s”

  1. roosterbear says:

    I would love to have a copy of this entry to throw at people who say “HIV is no longer a death sentence. It’s a treatable condition, like diabetes,” as if diabetes were some cake walk to manage.

    It’s so clearly not. Still, you sound like you’re doing a great job of handling what gets thrown your way.

  2. chrishansenhome says:

    Well, life is a death sentence, really. The stigma that has attached itself to HIV disease has to do with the perceived immoral habits that infected the person in the first place. Only children who got it from their mothers (and of course, in their case the stigma is only one generation removed…) and people who were infected from tainted blood products or needle sticks as caregivers are exempt from the stigma.

    Now the stigma attached to diabetes (especially Type II) is that many of those who have it are overweight. This means that people think that diabetics brought it on themselves by being fat pigs. I go to the doctor with the same mental attitude I had when I was going to an exam in school–if I haven’t lost weight or at least stayed the same, I flunk.

    I am thrilled by the medical advances in the last few years that allow those with HIV to live longer. If the 40 or so friends I lost in the 1980’s and 1990’s could have benefited from the new treatments, many might still be alive.

    I am also thrilled by the fact that items like laser surgery (only available within the last 25-30 years or so) has made it less likely that Type II diabetics will go blind.

    To those who say that HIV is manageable or treatable, just like diabetes, I say: “I don’t want a treatment, I want a cure. Now.” And that goes for any chronic condition.

    Thanks for replying, and if you do wish to use my entry or link to it, please feel free.