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Posts from the ‘Diabetes Complications’ Category

Eyeball Look-and-See.

I expected the traffic.

That’s a given, driving from southern Rhode Island up to Boston.  Even in the middle of the day, there’s traffic.  Aiming to make it for a 3.30 pm eye dilation appointment at the Joslin eye clinic means leaving at 1.15 pm in order to take the insane drive into account.

But we made it on time, with a whole 15 minutes to spare.  Insurance card provided, copay paid, husband waiting patiently in the waiting room while wife goes inside to have eyeballs dilated and examined.

The eye clinic scares me.  Always has.  There’s a feeling that washes over me every time I step into the waiting room, a sort of empty feeling of being left behind.  The walls are beige and the room they sit patients in while the dilation drops do their job is awash with muted colors and videos from National Geographic that play on repeat with subtitles, even though no one is watching.  Most people are staring in increasingly strange manners at magazines, reading becoming more difficult as the drops take effect.

I looked at my phone until the words became too blurry to read.  Before tucking the phone back into my purse, I tried to check my Dexcom result, but couldn’t read the actual number.  I went by the color – gray, which means “in range,” – thinking briefly about what it would be like if the world looked like this all the time, all blurry and weird.

It was a scary thought.  Sometimes the fear of “finding out” keeps me from making appointments on time.

This particular appointment was two months late.

I thought about complications and how we don’t often talk about them, how they’re dangled in front of us like a threat, a manifestation of our (in)abilities to take care of ourselves.  “If you don’t take care of yourself,” with the sentence always ending in a severed limb or a clouded eye.  Discussing complications in this way doesn’t help me follow through on the appointments that are required to screen for different issues, or to track existing ones.  They remain a secret, a whisper, a scarlet letter, something I’m supposed to give in to instead of fight back against.  It’s easy, at times, to reschedule these appointments.

I felt ashamed.  But I expected that, too. I hold my breath sometimes when the doctor is shining that bright light into my eye, blinding me briefly in a moment of irony.

I thought about my diabetes management over the last few months, with corners cut in some places in order to make strides in others.  I hoped my eyeballs reflected my effort.  Or at least that they held steady.

I did not expect improvement.  I didn’t expect the doctor to come in with a big grin on her face after reviewing the scans of my eyes, words like “Nice job,” and “Keep doing what you’re doing,” being issued.  I didn’t expect to see the leaking reversed or the swelling down. I didn’t expect to be grinning after my appointment.

But that’s what happened.

I thought about the things that have gone terribly wrong this year, and the things I wish I could change.  The stress of moments.  The impact that stress has on my blood sugars and my overall health.  The fact that diabetes and I have spent a lot of time together over these past 29 years.  So many variables, so much time, so many opportunities for things to go south.

“See you in a few months.  Your eyes look great.”

I didn’t expect to feel that kind of relief.  I expected to be moody and sullen on the ride home.  Instead, it felt okay to smile.  And to wear sunglasses in the dark, eliciting odd looks from Longwood medical district pedestrians.

 

Guest Post: Can Neither Confirm Nor Deny.

There’s power to the “me, too!” moments for sure, but there’s vulnerability involved in raising your hand first to say, “Me.”  Today, I have a guest post from a writer who wished to stay anonymous but who is looking for others who may have experienced something similar to what they went through.  If you’ve ever passed out or had a seizure, or have experienced a pocket of time where you know something diabetes-related happened but you can’t quite explain it, please leave a comment for this writer.  They need community now, more than ever.

*   *   *

The day was just like any other. Except it was a Friday before vacation where the afternoon is extra stressful to complete everything before heading out and not looking back for one week. That morning the Dexcom sensor was incredibly itchy, so I removed it.

When the work day was done I left with a bunch of errands to run before I could really enjoy myself. At the first stop I couldn’t find my wallet in my bag even though I knew it was in there. I was disoriented and didn’t know why. I kept apologizing.  I was so embarrassed about my lack of functionality that I returned to my car with nothing completed for my errand.

An hour later I “woke up” confused as to where my phone could possibly be. I found it in the trunk of my car. There is no memory of what happened after I sat down in my car (parked). However, as soon as I woke up I knew I had passed out. Presumably from a low blood sugar based on my actions during my errand. Based on the location of my phone, I believe it is possible I seized as well. I have no way to confirm or deny this assumption.

I do not know if this will ever happen again. I do not know how I came-to on my own. I do not know why I am lucky enough to have survived this. I do know that I reached out to my support system. I reached out to the people who would take it as is and not freak out. I was doing enough of that on my own. I do know that it is a hard event to move on from. I also know I’m not willing to let the whole world know yet.

But! Has anyone had this happen to them? Or something similar? How did you continue to live your whole life with diabetes without this always being in the back of your mind? Or front and center? Did you over treat? Or start treating almost lows, which weren’t lows but actually acceptable blood sugars? How do you keep your focus on your sugars and not raise your perception of what’s an “acceptable blood sugar”?

*   *   *

I’m glad you’re okay, Anonymous.

Guest Post: Let’s Talk About It.

Diagnosed with type 1 at age 15, Kimberly Hislop has been living with diabetes for 18 years. She’s been an insulin pumper since 2009.  Kim is currently studying psychology with hopes of one day working with people who have been diagnosed with chronic illnesses. She’s been a guest speaker for pharmacists, nurse practitioners, and physician assistants, teaching about diabetic complications from a patient’s perspective.  Her writing can be found at Deniabetic, and today she’s rounding out my week of guest blogs with a really important topic:  diabetes complications and learning to live well despite their diagnosis.

*   *   *

Being diagnosed with diabetes is scary. We quickly learn that we can overcome our fear of needles as we do what is necessary to survive. In my opinion, the hardest fear to conquer is the fear of the unknown. As a person living with diabetes we hear the terrifying word “complication” and our thoughts run down the black hole of “what ifs.” This black hole can be depressing and paralyzing for some. I truly believe that the diabetic community needs to start talking about complications. Most of us can name them but that is where it ends. If we could understand what the complications were and how to treat them it could possibly lower the fear factor.

Seems simple enough, right? So why don’t we talk about it?

To me, people with diabetes are truly afraid of three complications:  retinopathy, amputation, and kidney disease. I have had to deal with all three of these. I think it is so important to talk about these for a few reasons. When you can find someone who has SURVIVED these complications it gives you hope. You can see that there is life after complications. Also there is treatment out there. When you diagnosis complications early, there is a possibility of reversing it or at least stopping the progression. It is not necessarily a “done deal.” We need to talk about these things so that we can learn to be an advocate for ourselves. If it is a new diagnosis, you may not know what treatment is out there or even feel that you can ask for a second opinion.

My first complication was neuropathy. It came on five years after my diabetes diagnosis, when I was 20 years old. I did not know anyone who had this complication. It was incredibly painful and debilitating. I spent six months in a wheelchair and had horrible side effects from the medication. I felt shame, guilt, and really misunderstood. Mostly, I felt alone. I followed what the doctors told me to to but like with most complications, they can’t tell you for certain that you are going to be alright. I became suicidal because I couldn’t handle living with the pain. I spent a few days in a treatment program and from there started talk therapy on a regular basis.

For me, when I am diagnosed with a complication my first reaction is to figure out what I need to do to treat it, if it is an option. I think it is overwhelming to deal with my emotions while dealing with going to doctors and figuring out treatment.  And after a complication diagnosis, I always wonder why. Why me? Why did this happen? What caused it? The problem with diabetes is that it is a self-managed disease. Sometimes the only answer I can come up with for the question “Why?” is “because of me.” I think of all the things I did wrong such as,

I didn’t test enough.
I didn’t count my carbs right.
I didn’t cover with enough insulin.
I skipped my shot.
I didn’t exercise enough.

The hardest complication to face was my chronic kidney disease. I did not want to talk to anyone about it. It took me a year before I made it public and really I was forced to when I realized that I needed to find a live donor for a kidney transplant. I did not want pity from anyone. I did not want anyone to ask me if I was ok because in truth, I was not. I did not have the energy to fake it for the sake of others. I also felt like it was my fault. If only I had taken care of myself during my college years, instead of living with an A1C of 19% for two years. I felt like maybe I didn’t deserve a new kidney.

I was also incredibly freaked out about having someone else’s organ inside of me. I was sure that I would feel different. I wouldn’t be myself anymore. I even had pictures taken professionally about a month before my transplant as a reminder of who I once was. My guilt and shame kept me from reaching out to others who were transplant recipients. When I would go to the doctor’s office it would be filled with people 20+ years older than me.

I felt alone.

I know I am not the only one. The problem is that we feel such guilt and shame that we don’t talk about it. I don’t want to talk about my kidney transplant because I know that people will assume that I didn’t take care of myself. I don’t want to share about my retinopathy because clearly I caused that myself. If you have ever felt this way, raise your hand. The truth of the matter is … diabetes is not your fault. There are some people who take the best care of themselves and they do not suffer from any complications, some take the best care and do. There are those that ignore their diabetes completely and yet are never diagnosed with a complication. Sometimes there is just no explanation for any of this.

It is so important for our community to talk about complications and the fears associated with them. Instead of feeling shame and guilt, we need to stand together. When you are diagnosed with a complication it is imperative that you connect with someone who has gone through it. It can take away some of the unknown fear.  Every time I have been diagnosed with a complication I have felt “this is the worst thing that has ever happened to me.” In the moment, that is what it feels like. But somehow, you survive. It takes hard work both mentally and physically.

We need to discuss the importance of mental healthcare in all of this. It is only natural to feel depressed when diagnosed with a complication. The fact is, you can’t take the best care of yourself if you are not feeling good about yourself.  We need to figure out how to take the stigma of “it’s my fault” if you are diagnosed with a complication.

Complications suck but there is a life after being diagnosed with a complication. So … raise your hand if you want to talk about it. Let’s get this conversation started.

*    *   *

:: raises hand ::  I have written before about my own experiences with diabetes-related complications, and I know that sharing that information was simultaneously terrifying but also empowering.  By talking about the thing I needed the most information about and the most support with out in the open, I was motivated to move past fear and step towards positive actions to improve my health.  If you are dealing with complications, or simply scared by the thought, please raise your voice.  You are not alone.  And with early detection, early intervention, and good mental health support, we can find a very good life regardless of the road we’re on.  Thanks for sharing your story, Kim.  It’s an important one to share.

 

Entering the Mancave.

There are issues we talk about openly in the diabetes community – tips on how to wear a pump, resources for good diet and nutrition, exercise goals, frustrations with blood sugar control, research, and on and on.  All of these topics matter because they play a role in diabetes management, and life as a whole.  But some of these topics are easier than others.  It can be easy to say, “I suck at counting carbs and I need help!” but it’s another discussion entirely to give voice to, “I’m dealing with reproductive issues and I need support.”

Those personal issues need discussing as much as the topics like counting carbs.  Complications are delicate.  Fertility is delicate.  Sexual issues are delicate.  Depression is delicate.  These topics are raw and riddled with social stigma, but they need unpacking.  Otherwise, they get heavier, already heavy all their own.

I remember when I first read about a woman who had given birth after decades with type 1 diabetes and it soothed a panic in me that was there for years, that idea that motherhood was beyond my grasp.  It was a moment, a good moment, that helped change the course of how I approached becoming a mother.

But I also remember the first time I found stories from people in their 20s and 30s who were dealing with diabetes-related complications.  This moment was good in a completely different way.  My diagnosis of macular edema in 2013 generated more than just a new medical condition to manage, but stirred up all these feelings of failure, guilt, and blame … a deluge I wasn’t really prepared for.  These emotions aimed to drown me.  I wanted to hide.  I had very dark, very uncomfortable thoughts that took me away, in a sense, from my friends and family.  I needed support, and am grateful that I found it.  Conversations with peers about dealing with complications at a point when I still felt young but realized how many decades of diabetes I’d logged helped me get through the initial diagnosis and kept me on the path of taking care of myself in order to preserve and protect, but also to continue living despite this new diagnosis.

“Me, too!” stories can help do that.  They confirm that you aren’t alone in what you’re dealing with and that there is support and camaraderie available even in the darkest of times.

I wanted to share a new website called The Diabetes Mancave, created by a writer who has decided to remain anonymous but not to remain silent, and his website is hosting discussions about the topics of male infertility, retrograde ejaculation, and erectile dysfunction, among other things.  From the site:

“You’re not going find my real name here. That’s because this isn’t something I am comfortable sharing online with these issues, because they are very personal and not something I’m comfortable letting everyone tie to my name.

But that aside, this also isn’t about just me. It’s about these issues, and the larger point of how so many men who may be experiencing these, just don’t share because they aren’t comfortable talking about them.

… In a Diabetes Community where we so often tell each other “You Are Not Alone,” I certainly do feel alone.

I’m hoping the D-Man Cave can help remedy that, to some extent. Because I don’t want to keep this in anymore, and I don’t want to feel so alone.”

Discussions and blogs (and Twitter profiles) like his are long overdue.  I’m really sorry you’re dealing with these issues, Diabetes Mancave guy, but I am so, so grateful you are putting them out there.  I hope you find community and support because by putting your story out there, you’re potentially providing a life preserver for someone else.  Thank you for being brave, and encouraging others to be brave, too.

Does Not Compute.

“Do you guys have any fun plans for the summer?”

The question was simple enough, but not even close to a level my hypoglycemia-addled brain could handle.  I had trouble formulating a response, and the lag time was embarrassing.  We’ve only moved to the neighborhood a few months ago and haven’t solidified relationships with our neighbors yet, so being wickedly low in front of someone new wasn’t my favorite way to disclose my diabetes.

Thankfully, a disclosure had already happened, to a certain extent.  When she had asked me about my work travel this past week and what I did for work, I said that I worked in patient advocacy and that I’d had diabetes since I was a kid.  She nodded in recognition and shared that her college roommate was also T1D, so my disclosure was pleasantly subtle and streamlined.  No big deal.  What I hadn’t anticipated was going low during the course of our conversation.

And I was low.  Wickedly low.  The kind of low that made my face feel like it was full of Novocaine and that my hands were like birds at my sides, twitching and flapping absently.

I scanned the trees in the front yard for some kind of hint.

“Pssssst.  You guys!  You, trees!  Do I have fun plans for the summer?  HELP!”

They only waved their leaves at me.  “We have no idea!  Go get something to eat, dummy!”

“We go to Maine.  MAINE.”  I said it twice with way too much emphasis on the second one, an angry seal barking out their summer plans.  My neighbor didn’t seem to notice that my eyes weren’t able to focus on her, and I’m fairly certain she didn’t hear my Dexcom receiver hollering at me from the front steps of the house.  But I knew that another minute or two was the chasm between attempted conversation and calling for medical help, so I had to embrace the awkward.

“I’m so sorry; I know I mentioned that I have diabetes and you said your college roommate also had diabetes.  So I’m really, really low at the moment and I need to go inside to grab some juice.  Would you excuse me for a minute?”  I was trying to be polite and not let on that my thoughts were knocking around in my head like socks in a dryer.  She nodded and I took off for the kitchen, where I downed a glass of grape juice as quickly as I could.  My CGM only told me I was “LOW” and I cursed myself for not responding faster to the beeping.

Coming back outside, we stepped back into conversation without much pause, watching our kids play in the front yard.

“Sorry about that,” I said.  “No problem at all,” she warmly responded, not missing a beat.

And I kept an eye on my CGM graph, watching my blood sugars rise and kindly deposit thoughts back into my head.

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