July 31, 2008

Diabetes and Me: A Reporter’s Journey From Fear to Self-Control

By Louis Medina, The Bakersfield Californian

Jul. 31--The hair on my toes had never looked so good to me: It was a sign of healthy circulation, the young doctor at my HMO told me.

He hadn't put on gloves to handle my feet -- which in my emotionally vulnerable state seemed a really kind gesture.

He explained how, to prevent infection, I should examine the bottom of my feet for cuts periodically using a mirror. I should also cut my toenails straight across to keep them from growing into my flesh.

It wasn't as if I didn't already know these basic rules of hygiene or was in immediate danger of an infection or amputation -- not even close. He was simply teaching me useful ways to prevent one.

This sobering interaction earlier this year came on the heels of a session with a nutrition specialist. Carbs. Calories. Sodium. Cholesterol. Sugar. I would have to count these nutritional values carefully now. Every time I ate.

At 45, I was getting some tools to help me deal with the latest defining reality in my life, just like the more than 4,100 other Americans who get diagnosed daily with diabetes, according to the American Diabetes Association.


Diabetes is basically the body's inability to process the energy in food -- especially sugars -- because of an imbalance with the hormone insulin.

"It's due to either inadequate amounts of, or the inability to respond to, the insulin in the body," said Dr. Victor G. Ettinger, chief of Kern Medical Center's division of endocrinology and metabolism.

"That's the insidious part about diabetes: You'd think the more you eat the more energy you have, but it's the opposite," said John Kril, one of my high school buddies, who has had diabetes since childhood.

John explained the nature of the disease to me metaphorically: Imagine being a shut-in patient in need of food. Someone comes with aid but your door is locked and you don't have the key. They can leave the food on your doorstep but if you can't open the door, the food will stay outside and rot.

After my diagnosis in December, John and I have had a few amateur discussions on molecular biology on the phone.


There are three types of diabetes.

Type 1, or insulin-dependent diabetes, is when a person's pancreas produces little or no insulin, the key that "unlocks" the body's cells so they can get sugar from your bloodstream. Type 1 diabetics, like John, are often diagnosed in childhood -- although the disease can manifest at any age -- and need to take insulin.

Gestational diabetes affects pregnant women not previously diagnosed as diabetic. Their high blood glucose levels usually return to normal after delivery but the child is at higher risk for developing childhood obesity and both mother and child are at higher risk for Type 2 diabetes. Treatment varies and may include insulin shots.

Type 2 diabetes -- which has reached epidemic proportions -- is the most common type and it's what I have. It accounts for 90 percent of all diabetes diagnoses in America. It is also referred to as insulin resistance because the body can't properly use the insulin it produces. It doesn't go away but can be managed through diet, exercise, medications and insulin shots if necessary.


"None of these complications happen overnight," John said. "It catches up with you in a very slow process. And when the complications happen, they're irreversible."

Ettinger, who is not affiliated with my health care provider, said that by the time a person is diagnosed as pre-diabetic, 80 percent of the body's insulin-producing cells are already dead.

John, a former photojournalist, lost most of the sight in his right eye in 1996 to diabetic retinopathy. He said the blood vessels that supply oxygen and nutrients to the retina, which is like a thin piece of film in the back of the eye, grow but are unstable and can hemorrhage and rupture. When they contract, they can tear the retina. He had to have laser surgery on his left eye to prevent the same thing from happening to it.


When studying common risk factors for Type 2 diabetes, I realized I had just about all of them at the time of my diagnosis:

Age: I had just turned 45, around the age when Type 2, also called adult onset diabetes, manifests itself. With America's obesity epidemic, however, even kids are being diagnosed these days.

Weight: Although not morbidly obese at between 230 and 235 pounds at 5 feet 11 , I was about 60 pounds overweight for my frame. A layer of fat outside the cell walls, I was told in my nutrition classes, can make it more difficult for sugar to enter the cells. "The major challenge for all of us as physicians who deal with (diabetes) is the inappropriate intake of food," Ettinger said. "The kinds of foods that we're eating as a society and the quantity of food that we're eating are the major challenges."

Associated conditions: I had high blood pressure. This conditiion often accompanies diabetes, as high glucose levels in the blood can damage blood vessels. My blood pressure actually indicated to my doctors that I might have diabetes.

Family history: I had inherited a double-whammy gene, as my mother's father developed Type 2 in his old age as did my father, who also suffers from high blood pressure. Dad, unfortunately, didn't take care of these conditions well and his kidneys failed last fall. He is now on dialysis, needs insulin and also had to have arterial bypass surgery to ensure blood flow to his legs.

Ethnic/cultural factors: According to the ADA, being Hispanic put me at higher risk for developing Type 2. African-Americans, American Indians and Asian-Americans are also at higher risk for the disease, according to the National Institutes of Health.

I asked pharmacist Phillip Leung, who works in Bakersfield and Lynwood for a large drug store chain, why some ethnic groups are at risk.

"Asians, Caucasians, Hispanics, African-Americans ... You can't pinpoint it," he said of race as a factor. "With ethnic groups it's more of a lifestyle issue," he said, highlighting the high-carbohydrate, high-starch, deep-fried-food content of some diets. And among blacks, he said, there is a definite genetic prevalence toward high blood pressure, which often accompanies diabetes.

Chris Smith, the nationally renowned public speaker and author known as "The Diabetic Chef," said immigrants acclimating to life in America are particularly vulnerable because "their whole culture," including diet, "is being flipped upside down."

"They're coming to the U.S., where it's super expensive to live," he said. "Where do they eat? They will look at a fast-food place where they can get a cheap meal loaded with fat and sodium" and sugary soft drinks that can be refilled for free.


A lot of the nutritional information I got was overwhelming at first. But it became part of my lifesaver kit, along with the blood glucose meter, lancets and test strips to monitor my blood sugar levels daily. I was put on high blood pressure medication, too.

With the big-eating holidays coming up, there were times when Christmas party invitations sounded like death sentences to me.

But I had to count my blessings:

Doctors had detected my condition early, when I could still manage it without having to take insulin or meds.

At The Californian, I work near health reporter Emily Hagedorn, who helped with information and moral support, as did other friends.

I had a gym membership already and was using it about three times a week. I just started using it more.

Having witnessed my father's condition when his kidneys failed motivated me to not let the same thing happen to me.

By coincidence, or providence, my health care provider happens to have a diabetic center on its premises, where I could get help.


Still, my body needed major service. The way one nutritionist put it, when one is overweight and eating the wrong foods, he is forcing his pancreas to produce more and more insulin to digest elevated levels of sugar. This is similar to revving up a car engine constantly.

Eventually, it wears out.

Modern medicine brings hope, however.

"Five years ago I would have told you that eventually the pancreas will poop out," Ettinger said. "With some of the newer medications in the market, we believe we are in a position to prevent some people from permanently going on insulin and prevent the natural progression of the disease from occurring."

Nonetheless, I apologized to my pancreas. And I began exercising hard. My routine, which is more relaxed now, includes aerobic exercise and weight lifting, as well as walking and playing ball with my dog, Futuro.

I also started eating better, easing into healthy foods by starting with the ones I liked to begin with -- tofu, tomatoes, spinach, mushrooms, broccoli, eggplant, baby carrots, peas, beef jerky, bananas, raisins, nonfat cottage cheese, beans, hard-boiled eggs, cashews -- in measured quantities.

I started looking carefully at nutrition labels and eating more soups and making my own salads to take to work with me for lunch.

"Prepare your own meals. You now have the ability to control the food and the ingredients that go in there," Smith likes to say.


Eight months have passed since my diagnosis. I wanted to wait long enough to be able to write this with confidence: Diet and exercise do work.

At 186, I now weigh 45 pounds less then when I was diagnosed.

At that time, my Hemoglobin A1C reading, which is used to determine the average glucose content in one's blood over a period of time, was 6.2 -- the range for nondiabetics is 4.3 to 5.8. By early May, when I had the latest test done, it had come down to 5.4, well within the normal range. Without meds.

And my blood pressure is back to normal -- without meds, too.

I can't fool myself, however, into thinking I am cured: My blood glucose reading after meals still goes up above 110 milligrams of sugar for every 100 milliliters of blood, which doesn't happen to non-diabetics.

My goal, therefore, is to continue to manage my diabetes through diet, exercise, and tests every three to six months. And stress management is important as well, according to Smith, a Type 1 diabetic who says there is a correlation between stress and elevated blood sugars.


There is a saying in Spanish: "Dios aprieta pero no ahorca": "God squeezes but he doesn't choke." Sometimes a trial is what we need to get us to pay attention to what really matters in life.

Diabetes could have been a cause for depression in me. It could have been my undoing. But I'm making the best of it and, honestly, I'm the healthiest I've been in decades.

"It's one of the few diseases that you can definitely control," Smith says.

"They say the diabetic diet is the healthiest diet you can have," my friend John says. "It speaks about how bad we're getting as a group."

Leung and other health care professionals who know about my case encourage me to keep doing what I'm doing. They know of diabetics who don't change their lifestyle following a diagnosis. They are looking for a "magic bullet," Leung says, a quick-fix drug. But it doesn't work that way, he says: "Lifestyle modification is the magic bullet everyone's looking for, but it's difficult."

Actually, though, when I wiggle my hairy toes, which I can see just fine, and think about my healthy kidneys, and I'm finally -- Finally! -- not ashamed to go shopping for new clothes, I believe this type of lifestyle change is the easiest, most wonderfully sensible thing I have done for myself in years. I only wish I'd done it sooner.


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