What's Fair...

Sometimes writing a blog can be as educational as reading one. For instance, while doing research for this post, I discovered that the first recorded case of diabetes dates back to 1552 BC! Egyptian physician Hesy-Ra had no idea what was causing his patient's ailment, but was aware enough to note "frequent urination" as one of the illness's symptoms.

Of course, even knowing there was such a disease did little in the way of aiding treatment [the timeline linked to above notes that one 19th Century practitioner recommended a diet laden with sugar as therapeutic, while others suggested oatmeal, milk, rice, and even potato diets as helpful!].

Until the 20th Century, diabetes was rightly looked upon as a death sentence. Indeed, in one of the Sherlock Holmes mystery stories [written by Doctor Arthur Conan Doyle], Holmes chooses not to turn a murderer over to the police because, among other reasons, he was a diabetic, and likely to die soon.

The modern era of diabetes treatment began in 1921, when a team at the University of Toronto, led by Dr. F. G. Banting, first isolated insulin. Around 30 years later, oral medications were added to the arsenal of treatment. Research has continued on new treatments and, although diabetes is still incurable, it can be controlled by a combination of diet, exercise and, as needed, medication.

And yet...

And yet, diabetics can still face bias in their careers and everyday lives. Take Sonia Sotomayor, US President Barack Obama's candidate for the Supreme Court. Among other firsts, Sotamayor would, if confirmed by the Senate, become not only the first person of Hispanic ethnicity to serve on the High Court, but the first diabetic [given the age and health histories of some of the previous Justices, I have my doubts on that last point. But she would definitely be the first openly diabetic member]. While her selection has been welcomed in the diabetic community, some concerns have been raised. The argument says that, while Sotomayor seems to be in good health right now, complications arising from diabetes, as well as the on-going progression of diabetes itself, could leave her unable to serve an extended term on the Court [in the US, Supreme Court justices are appointed for life: in practice, however, the Court's members can and do resign when their health makes it impossible to serve]. Politics, of course, enters into the discussion [when doesn't it?]: Sotomayor is perceived as a moderate-to-liberal-leaning judge, based on her previous rulings, and those who agree with her decisions want to ensure that a Justice with that mindset serves as long as possible. Those who disagree with her previous rulings hope that, if she is turned down for the Court, the next candidate offered may be closer to their beliefs.

I am not an expert in law, or politics, or a lot of other things, for that matter. But I do see what goes on in the world, and I believe I can make observations based on what I've seen. I do not believe that anyone can predict the future. You can report statistics, make "educated guesses", or even just throw an idea out for consideration [the Criswell Predicts method]. Yes, Ms. Sotamayor may live a shorter life than other Hispanic women in similar health, but not diabetic. Then again, it is an unarguable fact, based on statistics, that women live, on average, five years longer than men. If another person became the Court nominee, that person could live a longer life than Sotomayor. Or they could be run over by a bus three months into their term. The point is, no one can predict the future. If opponents of Sotomayor base their arguments on opposition to her previous rulings, I respect their opinions, as I hope they would respect mine. But opposing her because of her state of health, or worse, using a health issue to cover other points of disagreement, is nothing more than a bias-laden ploy that should be naturally abhorrent to any fair-minded person. I hope things don't end up coming down to this.

-Mike Riley

Okay, What ELSE Can It DO?

The inquisitiveness of human nature may be one of our most-useful, as well as most-dangerous, character traits. YOU probably can think of "most-dangerous" examples without much help from me. But, for a moment, let's think about the "most-useful" trait of curiosity. For instance, who was that first brave person to get past the forbidding outer surface and enjoy a pineapple? What could have made him or her realize the sweetness that awaited beneath the skin? Or, picking a real hero, why did someone think that the inside parts of the artichoke plant would be good to eat [then again, as sometimes happens in bars at closing time with shots of hot sauce, could it have been a dare]? It's one of those questions that we'll never get a final answer to, but it does show the versatility we humans bring to the table.

Of course, this adaptability is not limited to our table habits. A tire iron is clearly designed for aiding in the removal or attaching of tires, but, in a pinch, it makes a fine weapon, suited for crashing across a rival figure skater's knee cap. What about the cottage industry that's sprung up around unintended uses for WD-40 [the company's official web site admits to over two thousand, and seems to demur only in cases of alleged medical uses]? Balding persons may recall that minoxidil, better known as Rogaine, was originally a high-blood pressure medication, that just happened to grow hair. Who knew?

This all came to me with word that Xoma Ltd, a medical company best known for its work in anti-inflammatory treatment, will report positive results this weekend for its Xoma 052 medication's Phase II testing on diabetics. Xoma 052, an anti-inflammatory, was reported as showing positive results in a presentation last weekend in Rome. Phase I testing was reported as successful last September, and the next report is expected at the American Diabetes Association 's 69th Scientific Sessions, being held in New Orleans. A couple of questions come out of all this:

-Did anyone realize that diabetes could be related to other illnesses caused by inflammation? Don't feel badly if you didn't; I didn't either, until I read a Xoma release that noted the inflammation angle has been under research for the last decade or so.

Xoma has high hopes for 052, believing it can aid sufferers of everything from rheumatoid arthritis, to heart disease, to, of course, diabetes.

-How effective is 052? I'm not a scientific expert, but some of the testing indicates fewer doses may be required than under current treatments. In fact, some research is indicating that as little as one dosage in 90 days, may cause a significant reduction in A1C levels. Anything that reduces the number of treatments will likely reduce the cost of treatment overall. Anything that can do that can help the millions of diabetics around the world that struggle to pay for treatment.

-Where can I get it? Nowhere yet. It's wrapping up Phase II testing in the US, and is on similar tracks in other countries. If the US FDA works at its usual pace, it'll probably be a year or two before Xoma 052 is generally available. This is not necessarily a bad thing. Considering the disaster that followed, for instance, the release of the diet drug fen-phen, a little caution is probably in order.

Is this a breakthrough? Maybe. Keep an eye out for more details as the research into anti-inflammatory and diabetes continues. This site will try to keep up.

-Mike Riley

Some Addicts Get Their Fix At McDonald's

One of my favorite TV shows when I was a kid was The Addams Family. I'm not sure why. Yeah, the action was frequently designed for the youngsters in the audience [lots of slapstick, things blowing up, etc]. Then there was Carolyn Jones, as "Morticia". She looked so good in that slinky long black dress, it might have single-handedly kick-started puberty in me! (Hang with me, Dear Friends; there is a point to all this...)

Years later [sometime in the 1970's, to be exact as I can], she was a guest on a radio interview show hosted by, of all people, Howard Cosell. During the broadcast, she referred to her husband at the time, who had a weight problem. She used the then-new term "food addict" to describe his eating style, then observed that food addicts are the only addicts who, by definition, have to use the addictive substance in everyday life. I've always thought it was an apt way to summarise the basic difficulty in weight loss for many people. (Of course, this isn't a weight-loss blog. And many diabetics, especially type I's, don't really have weight issues. But, as an obese type II, I think the topic is still valid for a diabetic blog.)

To start our examination, this article, part of a collaboration between ABC News and USA Today on health issues. It gives a good overview of the problem, and notes the difficulties in determining whether an eating disorder is food addiction or not [indeed, the article notes that there is no hard-and-fast definition of food addiction]. WebMD notes characteristics and signs of food addiction in this article, which connects food addiction with mental health. The website Springboard4Health.com [NB: the site sells nutritional supplements and other items as its principal reason for being, so its degree of unbiasedness may be questionable; however, the viewpoint its article on the subject takes is far from unique, and the article is well- and clearly-written] speculates that food allergies may be responsible for some so-called "food addictions". Finally, About.com notes the on-going controversy within the medical community about "food addiction" here.

Is there such a thing as "food addiction"? And, if so, what causes it [and, more

to the point, how can it be treated?]? Treatment will depend on the cause, and,

either way, the potential doesn't seem spectacular. If food addiction is a mental-health-related issue, most treatments seem to fall within the realm of "12-step" programs; many people find themselves unable or unwilling to complete such systems. If food addiction is caused by an allergy, the tedious, frequently drawn-out, and sometimes unsuccessful process of discovering what food is causing the allergy begins.

Is there such a thing as food addiction? Well, one of the finalists on the current edition of TV's The Biggest Loser has said he would formerly visit three or four fast food places during a relatively short drive. At each, he'd order a large amount of food, pull over, then consume his purchase by himself, in about five minutes. Compulsion, [perhaps] a specific food "trigger", shame [as an overeater, I certainly get this one]; it sure looks like food addiction, one way or another.

Is there hope for the food addict? Well, the person mentioned above is one of the finalists, so there is hope. But, like any addiction, there is also lots of hard work [physically and mentally] for anyone trying to get the Burger King off their back. The first challenge is finding a doctor willing to pursue the possibility; then, both doctor and patient must cautiously pursue whichever course of diagnosis and treatment seems most helpful.

-Mike Riley

Strength In Numbers

Whether it's building a barn or bringing your A1C number down, a few helping hands make the job easier. Depending on where you live, help may be close at hand. For instance, many communities have diabetic support groups. These groups usually hold open meetings on a regular basis, and are always looking for new members. Many times, these sessions pass along information on new diabetes treatment, new medications and advancements in technology [glucose monitors, pumps, etc]. They are also places to ask questions, share concerns, pass along experiences.

People joining groups sometimes find they are a bit shy; first of all, there is no shame in not knowing something. There is only shame if fear keeps you ignorant. People in support groups are almost always happy to share their knowledge, experiences and, yes, support [why do you think they're called "support" groups?]. Yeah, I know the image at right is about condom use [and, by the bye, if you're sexually active with multiple partners, condom use is a pretty darn good idea!], but the message works here too; "Dare to speak up, or shyness will kill you" [an interesting, if disturbing factoid from the International Diabetes Federation: nearly 7 % of the world's deaths each year are related in some way to diabetes. That's about the same rate of deaths worldwide attributed to HIV/AIDS. This is not a game...]

So, how do you find a support group? A good way to start is by asking your doctor or diabetic educator [you do have a doctor and diabetic educator as part of your treatment team, right? If not, go back a few posts and read this entry about who should be a part of that team]; they're probably aware of support groups in your area. If you live in a country with a strong diabetes association, it may have an office in your area. Give them a call. Look through the "events" section of your local newspaper, support groups usually publicize their meetings as well as they can. Many hospitals sponsor, or at least host, support group meetings. Give them a call [ask for the hospital's diabetic educator, if they have one]. If all these fail, why not start a group yourself? Now, that's brave! But it is doable. Contact one of the people you spoke to before, and ask for their help.

Of course, some areas just don't have support groups. Perhaps starting such a group is just not possible for you. Maybe you can't get to support group meetings. Or maybe you see yourself as a "lone wolf" [some people do]. There are [surprise!surprise!] online support groups. One I stumbled on just recently, and one I think you should at least look at, is TuDiabetes.com, an offshoot of the Diabetes Hands Foundation. A quick look at the discussion groups with in TuDiabetes reveals on-going entries on subjects as diverse as:

-pros and cons of glucose monitors

-users of one or more types of insulin

-questions and concerns of diabetics like you.

It's free to join, and, even if you find a good support group, it can serve as a source of information between group meetings [or give you something to talk about at that next meeting]. (Remember, any changes in your treatment should always be discussed with your doctor first.)

Don't let fear keep you out of the loop. Find a support group, check out TuDiabetes, stay informed! Knowledge is more than power; it's the first step in improving your health.

-Mike Riley

A=>B=>?

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"].