Friday, July 06, 2018


Since the Sixties docs have suggested that I might have diabetes and gave me the tests of the day in which one drank highly sugared water, waited a few hours, and had blood tested.  This never revealed diabetes.

Sometime after 2007 I went to the eye doctor for a checkup and he saw beginning damage from blood glucose being too high.  He recommended a female doc who told me my glucose reading was over 300 and that I must do exactly as she said or I would go blind and my feet would be cut off.  She gave me a prescription for a sulfonylurea, approved in 1957, the year I graduated from high school.

On the way home my blood sugar dropped so low that I nearly drove off the road.  Montana has a lucky feature: the roads are straight, simple and have little traffic.  Most parts are on level ground with no drop-offs at the edge.  Less helpful are the long distances between doctors.  When I called this doc to report overmedication, she and her nurse were angry.  But my meds were changed.  I've taken metformin ever since.

Valier has a little clinic once a week which is staffed by the hospital in Shelby.  That means the newest hire, the lowest on the totem pole, and sometimes Nurse Practitioners masquerading as MD's.  After my recent fiasco with an ear infection -- probably Miniere's rather than problems on the outside of the ear drum -- I thought it all over.  One doc had left Shelby and started an independent practice in Great Falls.  She had a colleague who owned a half-week clinic in Conrad, much closer.  I moved my treatment there and was pleased to find a male doctor who was not threatened by my computer explorations.

For months beforehand I had been noncompliant about drugs.  Partly my glucose numbers were going up and I blamed the machine, though I accidentally skipped doses and was not so strict about my no-sugar policy.  Partly this was because of doctors telling me contradictory and negative things, for instance, that diabetes was ALWAYS incremental and ended in death.  Or that surely a little Haagen-Dazs ice cream couldn't hurt me.  Transparently, they recommended what the pharma-salesman had just recommended, like "pens" to inject drugs.

In Portland long before I was diagnosed I worked as a clerical specialist next to a middle-aged, well-padded black woman I liked very much.  She had diabetes so severe that she had had a kidney transplant.  (Excess glucose erodes the lining of the kidney, which is why they always tell you to drink a lot of water to dilute urine.)  The transplant failed and because of that, she was now far down the list for a second try.  She was in so much misery that she often put her head on the desk, weeping, and missed many days of work.  I gave her half of my vacation days.  At lunch time she had to take a big bag of liquid into the lunch room and push it into her abdomen so that it would wash around until it became urine.  That was the Nineties so she is probably dead by now.

My own internist at the time, a heart surgeon specializing in surgical bypasses, had been made obsolete by optical fibers threaded through the blood system until occlusions were removed.  He was close to retirement so was piecing along with general practise.  He told me I had congestive heart failure.  My new doctor says he can find no signs of it.  

I'm taking advantage of the computer to research everything.  Computers are probably one reason that all my eye doctors have left the "practise-managed" larger institution in preference for a personal practice.   Instead of a helper who sat quietly in the darkened room and wrote down the doc's observations, the docs are now required to use a grid, forcing data into numerical amounts and predetermined categories.  This takes time and a learning curve besides converting a humanistic profession into an insurance salesman's data-scraping.  It also serves as a mark of "best practices" that defends docs against suspicious patients' lawsuits.  The trust and veneration of a profession is replaced by a mechanic's approach to metabolic malfunction.

The other side of computers is that I can sit here researching my meds and condition.  Not that this is pleasant for the docs who don't have time to do the same research.  Marketing info to docs is an industry but who checks for accuracy and effectiveness?

Many of the suggested causes of diabetes are (like computer error) blamed on the "user," the patient:  lack of exercise, wrong diet, elevated fat and blood pressure, overweight, ethnic origin -- though there are often pills purporting to fix the problem.  The lack of real knowledge is mostly obscured by whatever is coincident.  If you have the vocabulary to read this article (2016, probably by now obsolete at least in part since research is moving so quickly and in so many directions), you will find a broad approach.

My new doc and myself differ on the suggestion that high lipid scores raise glucose scores, so I have a lot more to read about that.  In the meantime I resist the popularity of Lipitor as treatment.  I'm impressed by two sentences in this article, as follows.

There are at least 40 genetic mutations known to be associated with type 2 diabetes.

. . . treating insulin-resistant patients with drugs such as sulfonylureas or injected insulin is actually followed by greater metabolic imbalance.

The article hints that too violent intervention can throw off the whole metabolic web which will take time to restabilize the little feeders and filters of molecules that "run" the body.  The complexity of the system and the rapidity of the research are what drive the need for a med-school-educated person to collaborate.  A third consideration is that docs control access to prescribed meds.  In fact, the insecure female medical people I've dealt with will frankly say,  "Either you obey me or I'll cut off your med supply."  Once in a while the pharmacist, a double-check on the system, has questioned the amount or kind of medicine.

Today I see that constant testing is being challenged as unhelpful since blood glucose goes up and down all the time, rather like blood pressure.  The "best practice" scores for blood pressure triggers meds at such low numbers that almost half of all people are defined as needing them.  How can such a prevalent condition be a disease?  Genomic research also challenges the idea of one norm: age, sex, region can affect scores.  Are they only the result of living a long time so that mechanisms of the body wear out?  We're gradually working my glucose scores down.

I'm 79.  I don't want to live a long time -- I want to live well.  My income is limited, I have many things to do, and I've always been self-caring.  This is the best I can do, so far.  But Google is not always trustworthy.  It tells me my new doc can cure pinworms (this is good!) and has been divorced fourteen times!

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