It’s Complicating


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?

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Russell Stamets
11 years ago

Great post. It knots my stomach. It’s a hell of a refresher for the fear that drives me. Being naive may have also helped me. 3 yrs ago at age 49, the LADA diagnosis was a bolt out of nowhere. I knew nothing about diabetes. I didn’t even try to learn much about it during an 18 month honeymoon. Metformin was working, I drank less, ate better, crossed my fingers. But in late 2010 when my A1c began to rise again and my doc said it would go steadily up until insulin was required, it scared the crap out of… Read more »

11 years ago

My partner is following a vegan diet with a lot vegetables and her medical tests are glowing.  Her A1C is still a little high, but otherwise she is in great health.  She’s clinically obese, but in the past year she’s shed close to 30 lbs. and we hope she’ll lose 20 lbs per year for the next few years until she reaches a healthy weight.

Steve Richert
11 years ago

Good blog post–hyperglycemia is my worst fear for the same reasons you highlight here. You really hit the nail on the head. Fear is what motivated me to live hard and fast (climbing and adventuring) because from what the docs told me upon diagnosis, I was pretty much fucked if I survived long enough anyhow! In the process I found that challenging the odds helped me manage my BG, oddly enough…but I still see spikes, like last night where I pinged off to 298 out of nowhere! Im not holding my breath for a cure for anything though, since in… Read more »

Kim Vlasnik
11 years ago

“Pickling eyeballs” is the most haunting image I’ve imagined in quite some time.

11 years ago

I just had two spoonfuls of cookie dough ice cream after a three years of missing it.  And I didn’t bolus.   It’s been one of those days.  One of those days when I thought… so what if I go up to 200 once in a while.  I love this post for your honesty.  I hate this post for its truth.


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