Like every diabetic I know, I don’t like to think about complications. Heart disease, nephropathy, neuropathy, retinopathy. Foot ulcers. Ugh. Like most diabetics, I don’t know what to say when someone tells me about the frequency of amputation or blindness.
My reasoning is simple: I am afraid. The threat is real. I myself have cataracts due to my lack of glycemic control during my teenage years. Driving at night is hard and disorienting, because all the lights are diffuse and haloed.
Even still, I am lucky– it could have been worse. And, I’m not by any means out of danger, because I have a lot of years left to live, and the physical offenses of hyperglycemia and hypoglycemia and cholesterol and chronic inflammation build up over time.
I don’t want to be sixty and blind. I don’t want to have necrotic lesions blocking my arteries. Excuse my being crass, but I have to be in order to conceal what is really grave fear: Fuck that shit.
So why am I thinking about all this? For work-related reasons, I have spent the last few days reading and thinking about the role of inflammation in diabetic complications, and that means learning about some of the molecular details of these complications. Endothelial dysfunction. Cytokines. Angiogenesis and remodeled optical nerves.
The threat is real. High glucose levels wreak havoc, especially when combined with high lipid levels. The human body is not designed to handle that sort of slow, rich assault.
I joke that a quarter of my brain is dedicated to diabetes management at any given moment. But that joke hides the reality– if I let go, if I say, “Just this once,” or “It’s just a few hours of high blood sugar,” I am risking serious damage to my body. Sure, a few high blood sugars measurements would go unnoticed over a lifetime. But it’s never just a few; diabetes is years of building up high blood sugars, of training my cells and my tissues to be pro-inflammatory.
We talk and we worry about hypoglycemia and sudden death, but this is the other side of that coin. Slow, progressive fibrosis of our organs. Wasting from over-abundance. Pickling my eyeballs.
Clearly, there must be some balance– I will not always be in range. That is the pain of diabetes. And, life happens, and sometimes it’s worth it to make a choice I know increases the chance I will become hyperglycemic for some time. But, knowing how much damage is done over time, I will first remind myself: it’s not just sugar in the blood. It’s sugar pelting every cell in the vascular system, firing my body up, burning it from the inside. Is it really worth it? Sometimes, yes. But I don’t like thinking about arteries pushing hard against the backs of my retinas. Or macrophages infiltrating my kidneys. Or atherosclerotic plaques slowing my blood. Fuck that shit.
Howabout this as a compromise: I do my best to manage my glucose levels now, and then we cure diabetes before I turn thirty-five?