Your Mileage May Vary

YMMV.

That particular acronym, standing for Your Mileage May Vary, is all too common on the insulin-pumpers’ website.

It applies to those of us with any chronic disease, and one of the main problems with “evidence-based” medicine is that it tends to rely on how the “average patient” reacts. There is no such animal as an “average patient.”

I had first-hand experience of this when a doctor, pre-pump, tried to put me on what he called a sliding scale of insulin, and gave it also to nurses in the local hospital. They insisted on using his scale when I was in the hospital for something else. I looked at the dose of insulin they insisted was necessary when my blood sugar was a little high at bedtime, and said “that’s going to put me into insulin shock.” They insisted on giving me the dose anyway. Luckily insulin shock still woke me up back then, and at 3 am I woke up shocky, hit the call button, and demanded a snack for insulin shock. They insisted on checking my blood sugar first, which only confirmed what I had tried to tell them earlier. I know now that that particular sliding scale, which was probably worked out for the average diabetic of my weight, simply did not work for me. I am very insulin sensitive, and while I absolutely need insulin and will see a very fast and uncontrolled rise of blood sugar without it, I need a very small amount, given my weight.

It isn’t just person-to-person differences, either. It can be time of day, time of month, stress, air bubbles, absorption rate of injected or infused insulin, or just the natural cussedness of the universe. Sometimes it can be how what you eat gets into your bloodstream.

Your blood sugar does not rise the instant you put carbohydrates into your mouth. The food has to be chewed and swallowed, as almost nothing is absorbed directly from the mouth or esophagus. It has to reach the stomach. One of the side affects of diabetes in many people is gastroparesis, which is delayed passage of food through the digestive system. To further confuse the person trying to keep diabetes under control, this delay is highly variable.

As a general rule, food I eat at breakfast time gets into my bloodstream, as glucose, fairly quickly. I’ve taken to eating yogurt for breakfast because most of the carbohydrates are lactose, which absorbs fairly slowly, and because the relatively high protein content also slows absorption. At noon my food absorption is a little slower, and by dinner time it’s slower yet – slow enough I normally spread my insulin out over 4 hours or so.

Changing my eating habits, as I did two days ago for Thanksgiving dinner, can cause an unexpected change in how fast the dinner actually gets into my bloodstream as glucose.

I didn’t have a huge dinner, or an unbalanced one, but I had more than normal, and upped my pre-meal insulin to compensate. I kept to a four-hour dual bolus, but by the time we went to another house for dessert, my blood sugar was running low. We had pie for dessert. I had a small piece, and I was still low, but I did take more insulin to balance the pie.

By the time I got home I was well into insulin shock, with a blood sugar below 50, and over the next two hours I ate enough to bring it up to normal by bedtime.

Four hours later my blood sugar was over 300.

I’m pretty sure that what happened was that the relatively large dinner caused more than the usual delay between swallowing food and the actual rise in blood sugar. As a result the amount of insulin I took, which was reasonable for the amount of food I ate, was enough to put me into insulin shock. Later that night the food caught up with the insulin, but by that time I had eaten enough extra to treat the shock earlier that my blood sugar went high.

The only way a doctor can prevent this is by insisting that you eat exactly the same meals at the same times every day. But we’re people. Most of us can’t keep up that kind of regime. And if we don’t accept that rigid a regime, we have to be intelligent enough to treat ourselves, to a certain extent.

I’ll probably do the same thing for Christmas dinner. But I’ll know to spread the insulin out over more than 4 hours.

Cranberry Recipes

The blade to my food processor. That black is supposed to be all one piece.

Disaster struck as I was preparing to start the salad for Thanksgiving dinner — the chopper blade on my food processor is broken. It was fine when I put it away, but now the plastic that holds the blade to the processor is shattered. Guess I’ll have to use the old mini-chopper for the cranberries and chop the rest of the stuff by hand.

Here’s a photojournal of the process of making the salad without a food processor. Turned out the mini-chopper did help with the oranges, too.

Ingredients and tools for the salad. (The paring knife didn't quite make the picture.)

Chopping celery's not that hard--just make a few cuts lengthwise before you start.

Yes, the whole naval orange is cut up. The mini-chopper took it down to small pieces.

Frozen cranberries and nuts help each other in the mini-chopper. It took three rounds, though.

The mini-chopper could not handle the apple wedges, so I had to chop them by hand. Apples were left to last, when I started heating the apple juice and water for the Jello.

What, all those solids for such a little bit of Jello? (I used orange, as I couldn't find lemon.)

The finished salad, ready for the refrigerator.

Recipes?

It’s anything-goes-day as well as Thanksgiving, so I thought I’d share a couple of my favorites. After all, they go well with turkey leftovers, too.

The first is my mother’s recipe for a Jello salad, modified to avoid added sugar and take advantage of a food processor. Note that while the usual Jello salad is Jello with fruit in it, this one is fruit, nuts and vegetables with a little Jello holding it together.

Cranberry-Orange Salad

2 4-serving or 1 8-serving packages of sugar-free lemon Jello
1 12 oz can frozen apple juice concentrate
1 c water
1 seedless orange, washed but unpeeled, cut into chunks
2 cups celery, cleaned and cut into pieces
2 washed apples (Granny Smith preferred), cores removed and cut in chunks
3 cups raw cranberries, washed and (preferably) frozen This is one 12 oz bag.
1 cup walnuts

Heat the water and apple juice concentrate together to boiling, and dissolve Jello. Meanwhile, use the food processor to chop (coarsely) the remaining ingredients. (It may take several batches.) Place the chopped ingredients in a 9” x 13” pan, level them, and pour the dissolved Jello over them. Mix and level to get all of the chopped ingredients below the liquid, and chill until set.

Makes 24 servings of 82 Calories each. For each 68-gram serving:
13 g carbohydrate
1 g protein
3 g fat (mostly from the nuts.)

Don’t laugh at the gram measurement – when I eat this I weigh the portion, and I use the carbohydrate and and half the protein to figure my insulin dosage. The recipe may have no added sugar, but with all the fruits and the apple juice concentrate, it’s far from sugar-free.

A half recipe would probably fit nicely into an 8” x 8” pan; I’ve just never tried it that way as this is my regular contribution to potlucks and Thanksgiving dinners.

The second recipe isn’t mine and is probably quite familiar to NPR listeners, but here is the link to Mama Stamberg’s cranberry relish. It may sound strange and look like Pepto-Bismol, but it’s yummy. I freeze it in an ice cube tray.

Happy Thanksgiving!

Measuring Blood Sugar

Back in the middle of the 20^th century, long before I had diabetes or even thought much about it, I saw a magazine ad that talked about diabetes. It might have been an insulin ad. What I do remember was that it featured a Russian troika – a three-horse hitch – and likened controlling diabetes to driving a troika. Three things have to be balanced: insulin, food and exercise, and misjudging any of the three can throw you to the wolves.

That balancing act is hard enough today, with all the tools we have to help. It was a lot harder 42 years ago, when I was diagnosed. And I hate to think of what it must have been like at the time of the ad.

The key is being able to keep track of your blood sugar. Really high, and you need insulin – exercise may actually push you higher. A little high, and aerobic exercise may bring you down. Too low, and you need food, preferably fast-acting carbohydrates. But at the time of the ad, measuring blood sugar meant several hours of lab work, and you might hear back from the doctor the next day. In order to utilize food, insulin and exercise optimally, you have to have some idea of what your blood sugar is right now, and whether it is rising or falling.

There are some symptoms. Sweating, shaking, blurred vision, and tingling lips can all be symptoms of low blood sugar. They can also be due to other things. (I was put on hormones at menopause primarily because I could not tell the difference between a hot flash and low blood sugar.) But those symptoms tend to decrease with years of living with diabetes.

Symptoms of high blood sugar are even subtler. I may start feeling a little odd when my blood sugar is three or four times normal, but my feelings were certainly not enough to tell me when I was high. Anyway, in those days doctors normally prescribed a fixed amount of insulin and a fairly rigid diet, and pretty much ignored exercise.

My current glucose monitor

What was desperately needed was a way for diabetics to find out what their blood sugar was, preferably without slashing their fingers with a modified razor blade. (That’s how they used to get blood samples.) Eventually, and over the initial objections of some physicians and regulatory agencies who were afraid that patients would self-treat, glucose monitors were developed. From the point of view of most diabetics, the objections were just plain silly. We have to treat ourselves. We give ourselves shots of insulin (which cannot be taken by mouth because it would simply be digested.) We exercise. We eat. Doesn’t it make sense that the more we know about which of the three we need, the better?

The first monitors were reportedly large, clunky and slow. They improved rapidly, and by the time I got my first one, in the late ’80s, they were pocket sized (if you had large pockets.) My testing kit today fits easily into the belt pouch I use as a purse. I still have to poke my fingers many times a day, but I get results in five seconds. One important thing is not covered, though – I can’t tell whether I’m going up or down from an instantaneous reading.

There is also a problem of expense. Tight control means testing before each meal, at bedtime, before you drive, regularly during driving, and every 20 to 30 minutes when exercising. Test strips are not cheap, and there is a real problem getting insurance companies to cover enough strips.

I’m not the only person with diabetes to feel this way, and there’s been a good deal of research on continuous glucose monitors. The first one I tried was the glucowatch. This used a patch sensor on the arm or wrist, and gave the blood sugar on the “face’ of the watch. It could also be read by a computer. Drawbacks? Many. First, it would only operate for 12 hours, and took a while without readings to initialize. Second, the patch was very irritating to my skin. I invariably had a major welt that lasted a week or more when I removed the watch and patch. Third, any sweat made the readings unreliable – and sweating is a symptom of low blood sugar. The watch did confirm that I was having low blood sugars at night and that I responded by “bouncing” high – a fairly common reaction, and much better than staying low with possibly fatal results. But the combination of problems led me to stop using it.

Modern continuous glucose monitors are much better, though by no means perfect, and I’ll talk about them, and the problems with getting insurance companies to cover them, in the future.

Conversation Piece

This is a bit of flash fiction, written in the Summer Arts Festival. The assignment was to write a conversation between two people who don’t understand each other, one of whom has some kind of dominance over the other. I’d call this a dysfunctional school, but this sort of incident can happen–we’ve had similar accounts on the insulin-pumpers e-group.

The small office was too warm, but Cyril never thought of shedding his coat.  Instead, he straightened his tie, pulled himself up in his chair and glared at the student standing in front of him.  “Well?”

The boy–what was his name?  Jerry?   Jimmy?  Jimmy, that was it–refused to meet his eyes and scuffed his right foot on the floor.  “I ain’t done nothing.  What you want to go pickin’ on me for?”  He shoved his hands in his pockets and turned his head, pretending to study the books on the wall.

“Speak properly, boy, and stand up straight.”  Damn kids today.  No respect.   Snotty twelve-year old, thinking he knew more than an adult.  And his hands were tied.  Couldn’t touch the little bastards, no matter how much a good spanking would straighten them out. “Trying to use a cell phone in class isn’t nothing, boy.  Now hand it here.”

Jimmy backed up a step, and his hand tightened around the phone in his pocket.  “Don’t have a cell phone.”  Sweat began to bead on his forehead.

Cecil stared at the boy, outraged by the lie.  “So what’s that in your pocket?”

“None of your business.”

Cyril stood up, lips compressed.  “Give it here.”

“No!”  Jimmy backed away another step, his eyes flickering to the closed door.

Furious, Cyril lunged toward the boy, grabbing the object the youngster held and pulling it away.  It was tethered by a cord to the pocket, and he jerked it free and threw it down.  He heard it smash as it hit the floor.

Jimmy screamed.  “You bastard.  He ran to the broken plastic case and picked it up, crying openly now.  “My mom’ll kill me.  I made her promise not to tell.  New school–I thought the other kids didn’t need to know.  And since the divorce…”

Cyril took the smashed electronics from the boy’s unresisting hands, and suddenly saw the words in the back of the case.  Insulin pump.

The Cost of Health Care

Why is health care growing steadily more expensive?

Well, there are quite a lot of reasons. But the most obvious to me, the elephant in the room (and I’d don’t mean the GOP elephant) is something never mentioned by politicians. What’s more, we all cheer it on.

I mean the advances in medical science.

Face it. One of the man reasons medicine is costing more and more is simply that doctors can do more and more.

Take my own case. A century ago, I would have died before getting my Ph.D., and the most a doctor could have done was tell me that I had diabetes and it would kill me, painfully, probably within a year if not a few weeks. Oh, my life could have been somewhat extended by a starvation diet, but I wouldn’t have lived long, and I probably would not have stacked up much medical cost.

42 years ago, when I was diagnosed as having diabetes, there was a treatment, insulin. It was cheap—a slaughterhouse byproduct. Hypodermics were glass, and my fingertips were often scalded because those glass syringes had to be taken apart and boiled before each use. Blood sugar tests? Those were carried out in a laboratory, and took several hours. Urine tests were available, but it didn’t take me long to realize that I could have urine sugar so high the tests would scarcely read it while I had every physical symptom of blood sugar so low I almost passed out. The medicine of the time kept me alive, but my diabetes was not exactly well controlled. Probably my eye problems today can be traced in part to this poor control.

Since then I have gladly discarded the glass syringes for disposable plastic, swapped beef-pork insulin for genetically engineered (and much more expensive) human insulin, learned to test my blood sugar with a finger prick, begun using artificial insulins genetically engineered to act faster and slower than human insulin, started using an insulin pump, and added a continuous blood sugar monitor. My diabetes is under far better control, and in fact my blood sugar is usually within the normal range. Thank goodness I have good insurance, because all of this is appallingly expensive.

Diabetes is by no means the only disease to see this kind of improvement in care at an increase in cost. Many cancers that were once fatal or “curable” only by gross mutilation can now be treated with far less invasive surgery, drugs and radiation. More and more conditions that were once a death sentence can be treated, even if few can be really cured.

And as one result, medical costs have skyrocketed. People for whom nothing could be done are now treatable.

Greater possibilities are not the only reason medical costs have climbed, and I’ll touch on some of the others later. But we have to recognize that at least part of the cost increase is simply because doctors can do something other than just tell a patient, “You’re going to die soon.”

Diabetes: What’s in a Name?

Two hundred years ago, a myriad of diseases were known by a single term: fever. We still use the word as a part of some disease names today – yellow fever, scarlet fever – but more often today the word “fever” is used to describe a symptom: body temperature above the narrow range that is normal for a human being. We have inoculations and other measures to prevent or cure many of the diseases once grouped as “fever,” and if those diseases had not been separated, this could never have happened.

Diabetes melltus, as defined today, is an elevation of blood sugar – more accurately, of blood glucose. Like body temperature, the human body needs a particular amount of sugar in the blood. Too much, and there are all kinds of long-term consequences to blood vessels and all that depend on them – kidneys, wound healing, eyes, the nervous system …. Too little and the brain, which more than any other organ requires glucose as a fuel, shuts down. (I’ve used this as a basis for esper shock in Homecoming and Tourist Trap.)

The body of a healthy person has a number of feedback mechanisms to keep both body temperature and blood glucose within the ranges necessary for life. Blood glucose feeds the cells of the body, but the use of blood glucose by the cells requires a hormone, insulin. If the blood glucose goes too high, the islets of Langerhans in the pancreas pump out more insulin. This allows the cells either to use the glucose for themselves, to store it short-term in muscles and liver, or to store it long-term as fat. If the blood glucose goes too low, glucose is released from the liver or used as fuel by the muscles which have stored it.

When these mechanisms go awry, the result is diabetes. But there are many ways they can go awry. You can treat a fever with aspirin, cold cloths, or ice, but to prevent or cure the fever, you need to know what is causing it. And there are many ways the regulation of blood sugar can go awry.

When I was first diagnosed with diabetes, 42 years ago, there were assumed to be two types of diabetes: juvenile and adult. On age, I fell in the crack. Juvenile diabetes required insulin, which must be injected into the body, and one simply does not get over this type of diabetes. Adult diabetes could often be treated with oral medications or even with diet. Since I did not respond to medication, I was assumed to have juvenile diabetes.

Today we have type 1 (defined as autoimmune destruction of the ability to produce insulin) type 2 (often considered due to overweight and lack of exercise, but there is evidence that fairly thin people can present with type 2) LADA, gestational diabetes (which may disappear immediately after the baby is born but may go on to develop into type 1 or type 2) and even a type that looks like type 1 but clears itself up. Not to mention the fact that the islets of Langerhans can be destroyed or damaged by things other than autoimmunity, such as chemicals or actual removal of or injury to the pancreas.

Why can’t we accept that diabetes is not in itself a disease, any more than fever is, but a symptom of a large number of diseases?

It is true that there are two major intermediate causes of diabetes, which may occur together or separately.

The more common cause, often associated with a modern sedentary lifestyle, is insulin resistance. There is plenty of insulin available, but the cells seem unable to use it to metabolize sugar. In fact, the body may overproduce insulin in an effort to make up for the insulin resistance, ultimately leading to the death of the insulin-producing cells and the need for insulin therapy. But this is an intermediate cause. The chances are that there are several underlying disease states that produce insulin resistance, some of which may be hereditary, dietary, lifestyle or chemicals. But we’re not likely to find them unless we quit lumping all insulin resistance as type 2 diabetes.

The rarer intermediate cause is an inability to produce insulin. If this inability is due to an autoimmune attack on the islets of Langerhans, the result is type 1 diabetes. That of course leaves the cases of insulin-dependent diabetes due to actual injury or destruction of the pancreas by other than autoimmunity, or the inability of the islets to produce insulin for reasons other than their destruction, out of the definition, though as far as treatment goes, they are type 1. Even the autoimmune destruction may have many triggers. Things as far apart as viruses and cows’ milk have been suggested.

Treatment is insulin – first obtained from beef and/or pork pancreases, but now biologically (bacterially) produced using the chemical structure of human insulin. Some insulins further modify this structure to give faster or slower action. Because insulin is a protein which would be destroyed by the digestive system, it must be given under the skin using a hypodermic, an insulin pen or an insulin pump. Without insulin, death can occur within days.

I’ll probably visit this subject again – it’s a favorite rant of mine. Meanwhile, the symptom of diabetes is increasing in frequency worldwide. Why? And which underlying diseases are actually increasing?

Complications of Diabetes

It’s nice to have at least one side effect of diabetes that isn’t a burden.

I refer to the loss of hair, and hence of the annoyance of shaving, on the legs, arms, hands, feet and underarms.

Not that I bothered to shave most of the time anyway, and it’s only a symptom of a much more serious diabetic problem — lack of blood flow to the extremities. In fact, it is probably related to my diabetic retinopathy and some autonomic neuropathy. Like my heart rate not speeding up when I exercise.

So what are the possible complications?

The American Diabetes Association has a daunting list, but the main ones are:

Eye complications. I’m very aware of those!

Diabetes is considered a risk factor equal to having had a previous heart attack for cardiovascular problems.

Kidney disease.

Stroke – again, I’m personally acquainted with that.

Foot problems – a lot of diabetics wind up with amputations.

Gastroparesis – highly variable delay in stomach emptying, which makes it very hard to treat low blood sugar.

So what can you do about it?

Don’t get diabetes is the obvious answer, but what if it’s too late for that?

Try to keep your blood sugar as close to normal as possible. That means checking your blood sugar frequently – probably a minimum of 4 times a day. I average more like 12 myself, even with a continuous monitor. It also means adjusting your insulin to the amount of food you eat. Carbohydrate counting is most accurate, but even then you have to figure out how much insulin you need to offset a given number of grams of carbohydrate. I went for years with a doctor telling me how much insulin to take and adjusting my food to match. He was prescribing too much insulin, and I gained weight.

Exercise helps, too. I have a stationary bicycle and a rowing machine set up in front of the television, and whenever I’m watching and not actually low, I’m exercising.

At least it’s possible to do something about tracking your blood sugar today. When I was diagnosed, 42 years ago, I got an occasional lab test – like every two or three years. And one shot a day of medium-acting insulin. Today we have not only blood glucose meters – all right, they do involve pricking your finger – but insulin pumps and continuous glucose monitors. They’re not perfect by any means, but things have come a long way in 42 years.

Now if the hair loss would just extend to my chin ….

Breast Cancer (Part 2)

As I mentioned last week, my primary concern was that my treatment for breast cancer had as little impact as possible on my diabetic control while having maximum effect on the cancer. I was well aware that chemotherapy would involve stress, and any kind of stress affects blood sugar. So when the oncologist gave me a choice of two types of chemotherapy drugs, I chose the milder but slower regime, 5-FU plus Methotrexate.

It was a mild regime in the sense of minimal side effects, but I had to get an infusion weekly for close to 5 months. And even with this regime I was warned that there was a good chance of nausea, losing my hair or anemia.

Luckily, I could get the infusions in Fairbanks, within driving distance of my home, and between the cancer center and VanTran I had a good chance of getting a ride if I got too sick to drive.

Remember I said that the diabetes actually helped me deal with the breast cancer diagnosis? It wasn’t all psychological. One of the things I have learned in my years of trying to keep my blood sugar under control is that I have to have regular exercise. I’m not much good at walking any more, but I have an exercise bike, a rowing machine and a treadmill all set up facing my television. About the only time I watch TV or a DVD without exercising at the same time is when my blood sugar is dangerously low.

I kept that up throughout the chemotherapy, with at least an hour a day of aerobic exercise. (I have an adult tricycle, too, but I didn’t ride that much the summer I was getting chemo.)

I honestly think that continuing to exercise throughout chemotherapy and radiation treatment had a lot to do with how few side effects I had. It may be that I was simply lucky, that I would have had few side effects from the chemo regardless. I can’t help but believe that some of my generally good health throughout the chemo was due to the fact that I continued regular exercise.

Having the rather large needles inserted into my hand was painful and annoying, especially as they always used the hand on the unoperated side, but I never had to have a shunt. Even my hair, while thinning, stayed on my head. I had to get blood tests before every session, and my white and red cell counts did get low enough I had to get some shots to build my blood back up, but I never really felt sick. I lost some weight I could well afford to lose, though unfortunately it didn’t stay off.

Most of the summer and early fall of 2008 I was driving to the cancer center every week for chemo. I did stretch the space between appointments once, to attend a family reunion. I’m glad I did, as it was my last chance to see two of my aunts, both then in their 90’s, who passed on a few months later.

I’ll talk next week about the radiation therapy.

Note—the Sunday blog would normally be about the genetics of the white splash gene in horses, but February 19 is Writing in the Dark, a writers’ conference held annually here in Fairbanks. Instead of the normal horse genetics, I’ll be blogging on the conference next Sunday. I’ll also encourage attendees to put samples of their writing at the conference up as comments. Our leader and inspiration will be Peggy Shumaker, our state writer laureate, and I’m really looking forward to it.

Diabetes and Blood Sugar

Blood glucose.

It’s something I have to worry about, as does every diabetic. Too much glucose in the blood, and the circulatory system is affected. This in turn can lead to problems with eyes, kidneys, feet, and the entire nervous system, not to mention cardiovascular problems. Diabetes is one of the leading causes of blindness, kidney failure, foot and leg amputations, heart attacks, stroke—in short, high blood sugar can kill you. Not rapidly, but the long tem effects of uncontrolled high blood sugar (hyperglycemia) are all too often lethal.

If your body starts breaking down fats and proteins for energy, which can happen if insulin levels in your blood drop too low, death can come in a few days, from ketoacidosis.

Low blood sugar can be just as much of a problem, and can kill you much faster. Your brain runs on glucose, so low blood sugar (hypoglycemia) affects the brain. It can kill you much faster than high blood sugar. Generally you can feel it coming on, but this awareness tends to fade with time—a condition called hypoglycemia unawareness.

A lot of people with diabetes wind up in emergency rooms because they simply pass out from low blood sugar, without warning. Some never wake up.

If you don’t have diabetes, you don’t have to think about this. When your blood sugar rises, your pancreas pumps out a hormone called insulin, which helps the cells of your body to use glucose, either for energy or in storage as fat. When it falls, your liver releases stored glucose to the blood. As a result, your blood sugar fluctuates only slightly, and you don’t really have to think about it.

For those of us with type 1 diabetes, the pancreas no longer manufactures insulin. For some of us, the liver no longer dumps glucose into our system when needed, either. Since we have to inject insulin (or have a pump deliver it) too much insulin, too little food, too much exercise or some unknown effect can make our blood sugar plummet. The treatment is sugar. Straight glucose is fastest, but any carbohydrate will do.

In Homecoming, the R’il’nai and R’il’noids have a similar problem. Esper work means using the brain—hard—and the brain runs on glucose. The liver can only dump a limited amount of sugar into the blood, and then it runs out of stored glucose. Too much esper work without readily available carbohydrates can cause low blood sugar, which they call “esper shock.”

When Roi is leaning to use his esper talents, one of the first things he has to learn is that he must eat while he is using those abilities, whether or not he feels hungry. How he feels in esper shock is based very much on my own experience and that of others with diabetes.

When I was first diagnosed, I had a number of symptoms—sweating, shaking, lips tingling. Others may get very aggressive, fight someone who is trying to get them to eat, or just not act like themselves. Still others quietly pass out. Right now, my most reliable symptom is a kind of flare in my visual field that blurs my vision, along with a feeling of weakness. I’d still have some real problems without a blood glucose meter (which requires a blood sample) and a continuous glucose monitor. I still wonder at how I got through the first years, before meters, let alone continuous monitors, were available

Now if they’d just make the alarm on the CGM loud enough to wake me up at night ….

Cataract Surgery Complications

Sometimes I wish Roi and his Healing ability were real, rather than a creation of my mind. Still, ordinary doctors can do quite a lot.

This week, it was complications of cataract surgery. I had the lens replaced in my left eye over a year ago, with stunning results. A few days after the surgery, distant vision in my left eye was back very close to 20/20, though I still needed glasses to read. I’m getting to the point where my arms just aren’t long enough, but my overall vision was wonderful.

Then, so slowly that I was hardly aware of it, my vision began to fog up again.

I found it harder and harder to read. First, words on paper. I had to use a magnifying glass to read the phone book, but then ordinary type in books became more and more difficult. The computer screen was still readable, but more and more often I was having to zoom the text and set things I was writing to half again normal size. When I started having problems reading my insulin pump and glucose meter, I spoke to my eye doctor.

I’ve had problems with diabetic retinopathy for almost twenty years. The treatment for that is what is called pan-retinal coagulation. The outer part of the retina is killed with pinpoint burns from a laser. Effectively, the periphery of the retina—which gives peripheral vision and low-light vision—is sacrificed to save the inner part, which gives sharp focus and color vision. I’ve had lots of experience with that kind of laser treatment. It’s somewhat painful and vision afterward is blurry and pink-tinged for a while. (The laser is green.)

What I had now was posterior capsule opacity. The eye doctor explained that the laser was less intense than what I was used to, though from my point of view the procedure was much the same—eye dilated, a lens inserted in my eye, and several minutes of holding my head motionless against a frame while I fixed the gaze of my other eye on a small target light.

I could hear the clicks as the doctor used the laser to cut a small hole in the thickened capsule, but I could not feel it. After I was released from the chair, my vision was blurry and pink-tinged, as I expected. What I did not expect was that by the time I got home, about an hour later, I was able to see much better than I could only that morning.

Today, forty hours after surgery, my vision is bright and clear, and if I understand correctly what the surgery did, it should stay that way. Yes, the Healing ability of a few of my characters would be nice—but medicine today can do some wonderful things—if you can afford it.