Friday, June 4, 2010

Major Learning Curve ...

Wow what a 24-hours I've just had!
I accompanied John to see his dietitian yesterday morning (as I have on each of his previous two visits) but this time I had a plan ...
Since John's diagnosis of pre-Type II Diabetes, and the resultant changes that have happened in this household, I have become very educated about diet and diabetes etc etc etc.  Thus far, John is doing very well in his efforts to avoid the actual diabetic status by closely following the diet that was developed for him and by incorporating exercise into his regime (hence, his weight loss). I, on the other hand, have been hanging on by my fingernails not to lose any more weight.
And to promote John's success in the program, I pushed for a blood glucose monitoring kit, which his doctor approved and we are now in possession of the necessary supplies for measuring blood sugar levels.
Education is a dangerous thing, as the saying goes ...
My eye doctor has been nagging for about two years now that diabetes could in fact explain the discrepancies she is finding in my vision.  My family doctor, however, has been insisting that because my blood sugar levels were always OK, there was no need to test further.
Now that we have the means to test, I undertook to do the "three day challenge" on me, (documentation explains that this is helpful, in the early days of one's diagnosis, to help the doctor determine how best to treat the patient).
The three day challenge involves taking your blood sugar at specific times of the day, for three consecutive days:  on waking (the "fasting" measurement); two hours after breakfast; just before lunch; two hours after lunch; just before dinner; two hours after dinner; and just before bedtime.
Armed with these numbers, the doctor is better able to understand what your body is doing and how best to treat the diabetes (as well as whether or not you are "pre" diabetic or already there).
The dietitian was delighted when she learned that we had a glucometer and had been monitoring John's numbers (and that we had brought them with us).  She was also some impressed with John's progress, even extending her hand in congratulations at the weight loss he had achieved in only three months (his girth reduction was even more impressive!).
Once she had assessed John's successful achievement and had told him to keep up the good work, I handed her the results of my three day challenge (without telling her that she was looking at my numbers) and asked her what the numbers told her.
She studied the card and was initially a little perplexed, then quickly realized that the numbers did not reflect John's pattern.
"Whose numbers are these?  Are these yours?" she asked.
"Yes," I said, "and without knowing anything else about me, how would you assess someone who presents with those numbers?"
"Well," she replied, "the fasting blood sugar is normal each day, but the spikes after your meals are quite dramatic.  These numbers are indicative of someone with Impaired Glucose Tolerance.  Which means that you too are pre-diabetic and you essentially need to do the same thing as John or you will become diabetic."
John's appointment with the dietitian then turned into my appointment with the dietitian.
And I have a follow-up appointment with her in early August (after I have seen my doctor, confirmed the findings, etc etc etc) so we can design a concrete diet plan specifically for me.
She explained that my pre-diabetes is different from John's in a significant way in that John's problem is one of his body's limited source of insulin (his pancreas do not produce sufficient insulin for his needs) but my body is insulin resistant (my pancreas produce sufficient insulin, I just don't utilize it properly).
John's fasting blood sugars will often be high (especially if he doesn't pay attention to his diet) and he is at risk of experiencing low blood sugar if he doesn't eat at prescribed intervals (and man, can he get ugly when that happens!).
My fasting blood sugars are almost always normal, but are often high two hours after eating.  I too am at risk of experiencing low blood sugar if I don't eat at prescribed intervals, but I can go without food longer than John can.
That's where the three-day challenge results are helpful; they provide the medical practitioner and the dietitian with the information they need to advise the patient how best to manage their type of diabetes.
While John's three day challenge results were quite different from mine, both our records indicate that we are pre-diabetic.  We just have to manage ourselves differently.
She also suggested that my numbers were probably much higher before I lost 40 pounds; my weight loss, although it happened as a result of a "crisis," has actually been a blessing in disguise.
As has John's Type-II Diabetes diagnosis proven to be a blessing in disguise -- for me.
For the past two years, my family doctor has resisted pursuing the possibility of diabetes contributing to my vision problems -- as suggested by my eye doctor -- because my "numbers were fine."
Now we know that my numbers were always going to be fine (until I eventually developed full-blown diabetes -- whenever that might have happened) because I have impaired glucose tolerance (IGT).  So he was being misled by my "good numbers."
At my last visit, he had finally ordered the required blood test to look for diabetes as an explanation for other complaints (my leg cramps being one of them).  And he had even told me to make sure I went for the test "two hours after having a good meal."  Now I know why he instructed me that way, and what he was suspecting.
My visit with him on June 24th will be most enlightening -- for him.
Because he should have the results of the bloodwork that was done at the end of May (two hours after lunch).  And I will have with me my three-day challenge numbers, which were also taken at the end of May and clearly show the IGT pattern.  I plan to repeat the challenge in the three days preceding my June visit.  By then, I will have been a month on the new diet I'm developing and I hope the numbers will reflect that I'm having some success in bringing down my blood sugar level at that two hour mark.
Oh the learning curve -- my brain hurts!

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