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Sometimes what you plan is not what you get. For instance, this was supposed to be an entry about how pale your fingernails are can be an indicator of diabetes, based on this item from WebMD. But, before I could write it, my reality changed.

For some time now, I have had swelling in my legs; it's believed to be a result of my heart attack in 1995. Before you ask, no, it's not painful, and, except for leaving me less than attractive in a pair of shorts, causes me no particular difficulties. But for the last few weeks, my left leg ballooned to a disturbing size. Walking became very difficult, and I was in great discomfort. Like most people, I was stalling seeing a doctor about it [I have an appointment with my regular physician early next month, and I thought it could wait]. A visit to my podiatrist last Friday changed my mind. He reminded me that I had had a blood clot in the leg two or three years ago, and that I should have it checked. So off to the Emergency Room I went [my doctor, for various reasons, is unavailable several times during the week], TheWomanILove dragging me, kicking and screaming a little [me, not her].

After several hours in ER, the physician on-duty decided it would be best to admit me. I spent the rest of the weekend, plus all of Monday and most of Tuesday in a hospital bed, waiting while the medical staff resolved the issue. Turns out I had an infection in the leg [source unknown as of this writing]; a regimen of antibiotics, along with a little rest, seems to be doing the trick.

Interesting, you're probably saying. But what has this to do with diabetes? A few things:

-diabetics are more prone to infections - it's very important for diabetics to keep up on any infections they do have, and vigilant about infections they may get [since, in addition to being easy targets for illness, we don't recover from them as easily as our non-diabetic friends].

-diabetes can lead to other serious complications - of course, it's difficult to prove that my diabetes led to my heart disease, which led to the heart attack, which led to the swelling, which might have contributed to my infection. But it's not an unlikely chain.

-diabetics need to stay on top of anything that's wrong with them - I don't know if this could have turned into something worse than it was. Fortunately, I'm not going to find out. But I'm stubborn. Don't you be stubborn.

-Mike Riley

"The only thing we have to fear is, fear itself"

Last time around, I talked a bit about fear. You know, the heart-pounding, sweat-inducing, adrenalin-pumping sensation. We've all been there. The last post was on doctor-office fear. But we all know that's far from the only one out there. My phobias include:
-birds flying freely indoors [especially inside supermarkets; what's the deal with that?],
-unexpected change, especially at work [one of my recurring nightmares involves me walking into my studio at work, only to find the equipment completely changed, and having no idea on how to use it],
-not getting the last cookie [O.K., as a diabetic I shouldn't be eating more than an occasional cookie in the first place. But I've wanted the last treat available since I was a child, and I'm not sure that one's going to change anytime soon].


But, based on my experience listening to and talking with diabetics [especially type II diabetics], the numero uno fear is...

THE NEEDLE.

I get it, of course. Most people equate insulin therapy with failure, with the continuing degeneration of their health, with jabbing a needle into yourself several times a day, for God's sake! That can't be good, can it?

Well, yeah. Let's begin with a quick review. Diabetes is a disease of the liver. Among other functions, the liver produces insulin, which the body uses to turn blood sugars into energy. In type I diabetes, the liver doesn't make insulin, forcing type I diabetics to inject it into their bodies. Pregnant women who contract gestational diabetes are also forced to use insulin temporarily, as oral medications aren't effective for them. Type II diabetics usually begin their treatment regimen with a combination of oral medications [like metformin], diet changes, and regular exercise. Metformin, and other oral medicines, work on the receptors that allow insulin to turn blood sugar into energy. But diabetes is a degenerative disease; it gets worse as your life continues. After a while, there is a risk of "burning out" the receptors through the stimulation of the oral meds. It just makes sense to add insulin, making the job of the receptors easier. Thus, injecting insulin becomes a greater and greater likelihood for type II diabetics.

There are reasons that people would rather not use insulin:
-injections are painful/difficult - Not so much, nowadays; in addition to the syringe/vial method, which can be difficult for some, insulin is available in the "pen" dispenser. It's small [really about the size of a pen], easy to dispense the correct amount [just set a dial on the device], simple and discreet to use [set the amount, screw a disposable needle on the dispenser, inject into an area of body fat, safely dispose of the needle, and you're done]. As for the needles, they are much thinner than they used to be, thus causing less pain [personally, I find jabbing my finger for blood sugar testing much more uncomfortable].
-insulin must be kept refrigerated until use - Most modern insulin can be stored at room temperatures for up to 28 days, some longer [this refers to the vial or pen in current use; those yet to be opened should be kept in the refrigerator, BUT NOT THE FREEZER].
-"I'm afraid I'll become addicted to insulin" - Not really. Insulin, in and of itself, is NOT addictive. The better your control through other means [medication, diet, exercise] becomes, the less insulin you may need. It may happen that you'll need to stay on insulin, but it's not due to using insulin.
-"I'll gain weight" - Okay, you've got me on that one. Many people who've gotten on insulin have gained some weight. But, with your sugars under better control, you'll almost certainly feel more like doing the exercise needed to take off those extra pounds. Besides, while carrying a few extra pounds is far from ideal, it's better than having higher-than-healthy blood sugar levels.

If you'd like a more complete look at how insulin is used to treat diabetes, WebMD has a good explanation here. The insulin manufacturer Sanofi Aventis operates the website GoInsulin.com; I'm a little reluctant to send you to a site operated by those with "an agenda". Noting that, the site is a good "support" source for those who, after conversation with their health-care providers, decide that insulin may be helpful in their treatment.

I've used insulin for a couple of years now, in addition to oral medication. I've used a long-lasting insulin for all that time, and recently have added a fast-acting product at mealtime. It helps me; it may or may not help you. Only you and your doctor can decide if you should use it. But it's not as difficult, painful, or complicated as you may have heard or believed. Don't reject it out of hand. Do your homework before making a decision.

-Mike Riley

"A little paranoid, are we?"

If you're like me, you probably rattle around this world with at least a few fears; nothing wrong with that, of course. Fear can be a healthy emotion. But only if it causes you to take some form of positive action. For instance, based on my conversations with other diabetics [and my own paranoid imaginings], there is much fear of losing a limb to disease. If that fear motivates you to take steps to help control your blood sugars better, as well as exercising to maintain the best conditioning possible for you, that fear has become a positive encouragement to healthy actions. Then again, if you are swept up in concern and negative imaginings [like the screaming man in the painting at left; incidentally, at least one theory on the Web says artist Edvard Munch was motivated by a crushing case of agoraphobia; who knew?] , the stress thus created will likely make it even harder to control your blood sugar levels, and possibly drain any interest you may have in activity, healthful or otherwise.

I don't know why, but my fear level rises several points while I'm sitting in my doctor's waiting room. It's not the fact that most of my fellow patients are superheroes [as illustrated at right]; come to think of it, why have we had to wait until 2009 for the introduction of diabetic superheroes? Anyway, I just get more and more paranoid waiting to see one of my doctors. I bet a few of you out there have, too. And you probably feel as foolish as I do when the fear comes.

But the real fear doesn't kick in until I'm actually in one of my doctors' examination

rooms; I've yet to figure out what sets my heart to trip-hammering when I'm sitting alone in that room, waiting for WHATEVER. I mean, I can be there, feeling good about my "numbers", my compliance with the treatment plan, my weight, my posture, everything. But still the fear comes.Why? I think it comes from a sense that, no matter how well I've kept to "the program", I have veered at least occasionally [trying to block a candy bar with my mouth, for instance]. (My late father, who was an LPN for many years, told me about "white coat syndrome", a theory that people, suffering the same kinds of fear that I do, actually raise their own stress, leading to artificially-high blood pressure readings, for instance. Something to that, I'd think. But "the fear" is there before I see the doctor [and why don't most doctors keep anything to read in those exam rooms? There's usually more than enough to read in the waiting room. Even if it's five-year-old issues of Time or Newsweek, it can help keep your mind off what's coming].

So, can anything bring Serenity to those moments before a doctor's appointment? Perhaps it starts with an acknowledgement that you have DONE YOUR BEST at compliance with your treatment, a belief that you may not be perfect, but you have made an effort to eat properly, exercise regularly, and followed the treatment program of your health care team. In the movie Animal House, Dean Wormer tells pledge "Flounder"[*], "Fat, drunk and stupid is no way to go through life". Well, paranoid and fearful is no way to go through life, either. Make the effort. Do what you're supposed to do, as best you can. Then face your doctor with a clear conscience [and probably good results, to boot].

-Mike Riley

* - "Flounder" was played by Steven Furst, who has, in real life, struggled with diabetes. In fact, he's even made a couple of videos and written a book on the subject. They can be ordered from the American Diabetes Association [click on the link above and to the left, under "Diabetes Information"].