Thinking about Diabetes Complications: Eyeballs and Knees

I’ve been thinking about complications a lot lately.

It started with one of my NOD mice– the little guy developed hyperglycemia, as expected. Her blood glucose was above 250 mg/dL, so I separated her from her siblings and came back the next day. (The blood glucose values vary a fair amount, so I ensure the mouse comes up above 200 mg/dL at least three times, each at least 24 hours apart.)

I didn’t end up getting to the third measurement until about 6 days later just because life got in the way. Under normal circumstances, that’s not a big deal; the mice seem to tolerate hyperglycemia for weeks before starting to get visibly ill.

Not this one, though. “This mouse looks pretty sick,” said the tech. And indeed she did– stiff and shivering, wasting away, skin on bones. Poor little thing.

My heart dropped. “I’m sorry, little guy! I didn’t mean for you to suffer!” I said to her in my head. I marked the cage for sacrifice and recited a quick eulogy to myself: “You died for science! We appreciate it!”

Later that night, I kept seeing the little shaking mouse in my mind’s eye. I felt guilty for having left her for that week, but also I felt afraid: diabetes did that. Please, God, don’t let that happen to me!

I went in to the optometrist at Kaiser today to get fitted for monovision contacts– one eye farsighted, one eye nearsighted. You see, I have cataracts because of my poor glucose control during adolescence, and so I have to get my lenses replaced soon. The good news is that cataract surgery is routine, outpatient: just pop in plastic lenses, and you’re good to go. The bad news is that plastic lenses are a sad imitation of the real ones, since they are not attached to the eye muscles, and thus I will lose the ability to focus at different distances. To mitigate this problem, the surgeons will put in one lens designed for distance vision, and one designed for close vision, and I will learn to focus with one eye at a time. The contacts are to practice this.

High levels of glucose change the osmotic pressure of blood as it flows through the body. The mere thought of that creeps me out.

But there is progress, always progress. The ease of achieving glycemic balance increases over time. Several weeks ago, my Minimed CGM transmitter started to give out. It doesn’t hold its charge very well now, and I have to recharge it for days at a time to make it work again. The Minimed rep told me that because the transmitter is more than two years old, she was surprised it was still working at all.

So I wrote to my doctor and said I wanted a Dexcom.

That was a Friday. The following Monday, the new Dexcom G4 approval was announced. And I thought to myself: am I lucky or what?

I went back and forth between Kaiser and Dexcom for a bit, and then today I got a call, right after the contact lens appointment, while a phlebotomist was setting up to draw my blood for an A1c. It was a local number, and I answered. It was Sean, from Dexcom, letting me know the order had come in from Kaiser, and my new CGM would ship out that day. “Ow!” I thought, because the phlebotomist had just inserted the needle. Then, “Yay!” because I was getting a Dexcom G4. (Like a G6, like a G6.) 

As I left the Kaiser lab, arm taped up, I saw a man in a wheelchair. Big guy, leg amputated at the knee. “Probably diabetes,” I thought to myself. And then: Please, God, let my A1c be good.

Good, bad, those are moral terms we apply to medical assays. I shouldn’t do that.

Maybe. But on the other hand, dysregulated growth factors and increased osmotic pressure? Bad. Keeping my legs? Good.

I should think less about complications.

Karmel Allison

Karmel was born in Southern California, diagnosed with Type 1 Diabetes at the age of nine, and educated at UC Berkeley. Karmel now lives in San Diego with her husband, where she is loving the sunshine, working in computational biology at the University of California, San Diego, and learning to use the active voice when talking about her diabetes.

Karmel Allison

Karmel was born in Southern California, diagnosed with Type 1 Diabetes at the age of nine, and educated at UC Berkeley. Karmel now lives in San Diego with her husband, where she is loving the sunshine, working in computational biology at the University of California, San Diego, and learning to use the active voice when talking about her diabetes.