Confusion reigns supreme!

Confusion!  The story of my life, apparently.

I met with the dietitian this morning to discuss my presumed "Impaired Glucose Tolerance" status.  I was armed with numbers dating back to April, including the results of three separate "Three Day Challenges" and they all supported her original diagnosis.

You will recall that the last time John met with her, I had her assess my initial findings and I thought that she had explained my pre-diabetes as different from John's in that his problem is one of his body's limited source of insulin (his pancreas do not produce sufficient insulin for his needs), but my body was insulin resistant (my pancreas produce sufficient insulin, I just don't utilize it properly).

Yeh, well, throw that explanation out the window.  I had it totally backwards.

It is I who do not produce sufficient insulin for my body's needs, and John who is insulin resistant (his body produces sufficient insulin but has lost its ability to utilize it properly).

Both conditions lead to diabetes.

Both conditions carry the same risks.

Both conditions are managed the same way -- diet and exercise, eventually medication if need be (to be avoided, obviously).

But each condition is caused by a different physiology (lack of insulin vs insulin resistance).

My particular difficulty, as near as she can tell from the logs I provided, comes from carbohydrate overload.  I clearly eat too many carbohydrates at each sitting, especially breakfast, and my body doesn't produce enough insulin to deal with it.  By the time I add the carb overload at lunch time, my body is "scrambling" to process it but simply can't do it because I lack sufficient insulin for the task.  The answer, then, is to better manage my carbohydrate intake.

She explained that there are some doctors in her treatment area who would, immediately upon seeing my numbers, start me on medication because my numbers clearly indicate insufficient insulin production.  But in my case, because of my many "issues" with medications, we want to avoid that route at all costs.

My doctor, on the other hand, declares emphatically that I am "not diabetic" because my fasting glucose numbers are within normal range and my glucose tolerance test reported normal.  He's right of course.  I'm not diabetic.  My challenge now, of course, will be to convince him that the numbers don't lie and IGT is a recognized pre-diabetic condition that needs to be addressed and monitored.  (I am addressing it by consulting with the dietitian, but it is incumbent upon my doctor to order the necessary medical tests.)

Now, I know that I won't have any difficulty with that discussion with my doctor because he is a reasonable man and he will accept the documentation and the report I give him of this morning's visit.  But I have had an ongoing "argument" with him for over two years about my vision being a problem and the possibility of diabetes being a factor in that issue.  And now the dietitian (someone I chose to consult; he did not refer me to her) is telling me that he will have to monitor my kidney function, and that my hemoglobin A1C should be tested at least annually.  That's the test he had resisted doing until very recently -- although it will probably show normal, just as it did in June in spite of all the other peaks I've documented.

Anyway, the dietitian made one minor alteration to my diet right now, to see if I'll be able to record more normal readings.  I'll wait about ten days before undertaking another three day challenge, and I see her again in six weeks.  Only then might she make any further changes to my diet because, as she says, I'm doing extremely well on my own.  She says my numbers are very good for someone with IGT so that tells her that I am already managing it very well.

We will revisit the issue in six weeks.

Maybe by then my cloud of confusion will be lifted somewhat.

"Balance your diet -- eat regularly -- ensure you have sufficient carbs and protein at each meal -- have a set number of servings of Grains & Starches, Milk & Alternatives, Vegetables and Fruits every day -- don't exceed a set number of carbs at any one sitting -- and oh yeh -- make sure you have a banana a day (keep that potassium level up) -- and don't forget your Meat or Alternative every day -- but don't gain any weight, and don't lose more than five pounds -- here's a list of foods with their carb content (three or four of these choices per meal) -- here's a list of foods to avoid -- here's a list of foods high in potassium (oops, we just told you to avoid many of those ones!)."

Eventually, I'm sure I'll figure it all out and I'll find a balance -- maybe.