Knowing my body, part 1

Two quick notes: Today's post expresses some frustration with the medical establishment, but you should notice two things that are not there.

1. There is no reason to try and extrapolate it to anything about vaccinations, which I fully support as a measure in support of personal health and as a matter of doing the least possible to be a decent human being.
2. There are no requests for advice.
   

I have diabetes. That means that I have to be concerned with my blood sugar. 

Too high sugar levels in my blood can cause organ and nerve damage over time; no one wants that. Taking things to correct for that may sometimes work too well, though, and if my blood sugar goes too low that can lead to other symptoms. Comas are possible in either direction.

The sugar from the food you eat gets absorbed into your cells, promoted via a hormone called insulin, manufactured by your pancreas. Therefore, you might assume that high blood sugar is a result of non-functioning or at least under-performing pancreas. That is commonly an issue, but other things can affect it too. 

Your liver will release sugar back into the bloodstream at night. Sometimes it overdoes that. Then you might wake up with higher blood sugar, but have it normalize during the day. Sometimes there is also insulin resistance, where your body does not react to the insulin well. Then your pancreas might not only be performing, but producing too much trying to compensate.

I write that because people make a lot of assumptions about diabetes, that frequently correlate with assumptions about fat people, but it is more complicated than that.

(For example, in children there is an assumption that it is just a faulty pancreas, and they call that Type 1 diabetes, and that you don't get to blame the patient for it. Both types are increasing now, and I suspect some of the perceived distinction may be unhelpful)

When I first got diagnosed with diabetes, I had excellent insurance. That may have been the luckiest break of my life. It came on the scene with an infection that required hospitalization, but that was all covered, plus an education class that put me in good stead.

Then, when I lost that job and did not have good insurance or a regular doctor, I went to a walk-in clinic where it was a different doctor every time. Some of them were good but a lot of them were not great. I did not do so well.

Then I got a better job and a referral to an endocrinologist. Things were really under control. Yes, it required expensive medication, but I could manage the co-pays, and I was doing well.

Then, I was unemployed again and became a caregiver. That disrupted everything.

I am blessed to live in a state that believes that poor people deserve medical care, but the quality may still be lower. No endocrinologist this time, but they did have a pharmacist that I would have phone calls with, going over my blood sugar scores and adjusting doses.

Getting back to the complexity of diabetes, I mentioned some things that affect it, but there are a lot more. How much water you drink matters, because dehydration concentrates your blood sugar and because dehydration makes everything in your body run worse.

Sleep affects your blood sugar.

Stress might.

What you eat and how much affects it of course, but different people react differently to different foods, beyond the mere measure of the carbohydrates inside. Some people have their blood sugar go higher than you would expect with tomatoes, but a lot of people do really well with nopales. 

I do great when I have a sausage McMuffin for breakfast; I suspect it's the (delicious) protein boost. It still doesn't mean I should have one every day. There is an extent though, where you need to figure out what works for your body, and you are the only person who can know.

There had been a lot of things going on in my life where I was not as good as I should have been for blood sugar. Generally you want to be under 6 for your A1C, and I was running at 7.

The pharmacist kept upping my dose of insulin. I felt like that wasn't the real issue, but I wasn't fighting it because even if I knew that I was not getting enough sleep ever, and not always enough hydration, the circumstances in my life that made that a problem were not changing.

Getting back to those assumptions: there is commonly an assumption of non-compliance with fat patients and with diabetic patients. If it's a fat diabetic... oh boy! That made it harder for me to argue.

Did I mention that since insulin promotes sugar absorption, more of it promotes weight gain?

Over that time period where they kept raising the insulin dose, I gained thirty pounds and my A1C went up to 9.

I finally found my anger. Maybe I finally had recovered enough from the caregiver burnout to have enough energy to hold anger. We were going to lower the doses, and I didn't want to be reckless about it, but her strategy was literally making me sicker.

They hate not medicating you though. It's not that there are bad intentions or a lack of caring, but especially for a pharmacist, what other options are they even trained to see? 

I am now injecting yet another medication, though only weekly for this one. 

I am taking less insulin. My blood sugar is going down, though it also goes low more often. 

The extra fat is probably going to be more resistant, which is not great, because that can be a contributor to insulin resistance.

I should also mention here that I take a statin even though my cholesterol has never been high. Statins are recommended for people with diabetes (especially if you're fat), because they always think you are going to keel over of a heart attack. I resisted for a year on that one, and my cholesterol still never did anything bad, and but the doctor kept pushing and I gave up.

Initially when I was thinking about writing this, I thought it was going to be about my frustration with myself that I didn't put my foot down sooner. The first time my A1C was higher after the increased dose, I should have pushed back then, though also, I would like to think the professional might have had second thoughts about it. 

It is easy to be intimidated and think you should trust the authority figures, even if a lot of what they say comes via pharmaceutical reps pushing studies sponsored by pharmaceutical companies.

And yet somehow, having typed all of this up, I can't help wondering if the issue might be more systemic than a matter of personal responsibility.