This is a diary I've been meaning to write for awhile.
It shouldn't have taken this moment to get me to take action, but there you have it; in the end, my reaction (perhaps mistaken) to yesterday's news is what it took.
Diabetes can be like that; it's a silent disease.
Diabetes is not always easy to talk or think about, even when it affects you or someone you love directly. Which is a shame, because diabetes is also something that all of us, diabetic or not, can do something about. Diabetes is a disease that responds to our actions and words.
Maybe today, in our own small way, some of us can put a stop to that silence for ten minutes here on dailykos. If you're interested join me below...
the prevalence of Diabetes
According to Center for Disease Control statistics 7% of the United States population...20 million Americans...or what would amount to 9,000 of us who are registered at dkos, currently have diabetes. Of that national number about one third, 6 million Americans, have diabetes and do not currently know it.
Further, according to the CDC another 14-18% of Americans...54 million people...have blood sugar levels putting us in the category of pre-diabetes, a serious health condition that, if left untreated, almost certainly leads to developing Type 2 diabetes later on in life. In terms of the community here at dailykos that would mean that there are 18,000-22,000 of us registered users with pre-diabetes.
Those are significant numbers. There are 74 million Americans with either diabetes or its precursor. Applied to us here at dkos that means that perhaps 30,000 of the 125,000 users here, almost 1 in 4 of us, deals personally with diabetes in some form every day...whether we know it or not.
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The goal of this diary is two-fold.
I'd like to start to explain, briefly, what diabetes is on a very basic level for those who don't know or are only vaguely familiar with the disease. I'd also like to start a conversation about diabetes that might encourage folks who don't currently know but think they might be at risk of either having diabetes or pre-diabetes to take the first steps to take care of themselves and find out.
If you have diabetes or pre-diabetes and already know it, nothing much of what I write below will likely be news to you. And if you have Type I diabetes or LADA, please understand that what I write below, will, of necessity reflect the fact that the 90% of the 74 million Americans dealing with diabetes, especially those many millions who have it and don't know it yet, are dealing with Type II diabetes.
Either way, I'd like to send a message to readers of this essay who are living with diabetes: if I get something wrong here, or if you have some advice or experience you'd like to share or add to this diary, especially words of encouragement and optimism that might get folks to take the steps they need to address their health, please feel empowered to share your experiences and views in the comments below in a way that works for you.
I really want to be clear on this; even though I've titled this essay "breaking the silence" that does not mean I expect anyone to share something personal that they aren't ready to, or don't want to share, now, or perhaps, ever, on dailykos. That's something I take pretty seriously. Breaking the silence is a metaphor more than anything.
In that light, I've put a poll at the end of this diary. It's an anonymous poll. No one is expected to discuss how they answered it. It's for us to learn a bit, that's all.
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Diabetes Basics: it's about equilibrium
The human body is made up of complex systems for maintaining equilibrium. Maintaining the body's systems in a healthy equilibrium, in fact, is another way to describe "good health." One of the essential systems of equilibrium in the human body is the regulation of glucose in our blood stream.
Glucose, or blood sugar, is an essential fuel for our body's cells. Glucose fuels our brain, our organs and our muscles. We humans need a steady and even supply of glucose in our bloodstream, and a healthy body, through our endocrine system, will maintain an equilibrium that keeps our blood glucose level at a very even keel: for most of us, usually between 80 and 90 mg/dL except, briefly, for an hour or two after meals.
Diabetes is a disease where the system of equilibrium controlling the level of glucose in the bloodstream loses its balance. With uncontrolled diabetes, blood sugars, or what doctors refer to as blood glucose levels, often go too high and, more rarely, too low.
The human body really does not like when blood glucose is too high. That condition is called hyperglycemia. Persistent hyperglycemia is the predominant feature of diabetes and pre-diabetes even if it's something we don't notice while it is happening.
The human body also really does not like when blood glucose is too low. That condition is called hypoglycemia, which, in simplistic terms, is a more serious version of what people commonly refer to in conversation as having "low blood sugar." Severe hypoglycemia is primarily a concern for those who are taking medication or insulin to control their blood sugar. For diabetics, severe hypoglycemia is a very serious and potentially life-threatening condition. It's why many diabetics wear medical ID bracelets, measure their blood sugars carefully, and keep sugar tablets (or some sugar-based food or drink) on their person in case of a severe hypoglycemic emergency.
For most of us, however, our bodies have kept our blood sugars in a very tight equilibrium for all of our lives. We may have felt the occasional "high" after eating too much sugar or "low" when we were active and hungry. But for the most part, our body's equilibrium controlling blood glucose levels works, has worked, and will work like clockwork for the rest of our lives.
With diabetes, it's different. The equilibrium governing blood sugar becomes impaired, and diabetics have to learn what steps they need to take to regain control.
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Diabetes and Hyperglycemia:
The classic early-warning symptoms of diabetes are excessive thirst and frequent urination. There's a reason for this.
Our bodies really don't like having excessive levels of glucose in our blood. Normally, after a meal our body, triggered by our hormones, uses insulin to quickly regulate the sugar in our bloodstream. With diabetes there is either not enough insulin, or it is not able to work effectively enough, to prevent blood glucose from rising well above the 80-90 mg/dL equilibrium it likes to return to in the hour or two after eating. With diabetes, blood sugars rise to levels above 140 mg/dL more than two hours after meals and linger there. Even in the morning, after fasting all night, blood sugars will remain high: between 100-125 mg/dL for those with pre-diabetes, or impaired fasting glucose, and over 125 mg/dL for those with diabetes itself.
This high blood sugar is called hyperglycemia. In effect, hyperglycemia makes us thirsty and leads to frequent urination because our body is trying to get back to equilibrium by using our kidneys to remove the excess glucose from our blood. Like I said, our bodies really do not like having high blood sugar. In fact, high levels of glucose in our bloodstream are the cause of the very serious and long term complications of diabetes.
Hyperglycemia causes the macrovascular (heart attack, stroke) and microvascular (damage to the kidneys, eyes, nerves) complications associated with diabetes. These complications are what make diabetes such a very scary and very serious disease. Diabetes is a leading cause of blindness, heart attack, stroke, kidney failure, neuropathy and pre-mature death. And what's important to understand here is that diabetes is an "always on" and systemic disease. When blood sugars increase to hyperglycemic levels, eg., when diabetes is not in control, damage is done, silently, to our circulatory system, our nerves and internal organs like our kidneys and pancreas. In fact, hyperglycemia, by damaging our pancreatic beta cells, can impair our ability to produce our own insulin eventually at all.
What makes diabetes such a silent disease is that once we get used to having high blood sugar, it's very possible to not really notice that this is going on. It is very easy to get accustomed to having hyperglycemia even though it may manifest itself in excessive thirst and hunger, frequent urination, eye problems and blurry vision, slow wound healing, erectile dysfunction and swings in mood and energy level related to eating patterns. The analogy of the frog in boiling water is very apt in this regard. The tragedy of this disease is that by the time many of us find out about it, diabetes may already have created a system-wide impact on our bodies.
This silent damage is why one third of Americans with full-on diabetes do not know it, and why probably even a higher percentage of the 54 million Americans with pre-diabetes have little idea about what's happening to their bodies. Which is a shame, because the persistent hyperglycemia caused by diabetes, even at low levels, is both deeply unhealthy and, more to the point, something we can do something about.
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Taking action: Diabetes and Pre-Diabetes
The essential treatment for diabetes in all its forms is to reestablish as healthy an equilibrium of blood glucose levels as possible, what doctors call 'control.' There is real cause for optimism about this, especially when undertaken early in the process.
For some, especially those with pre-diabetes, control may well be possible simply from weight loss, changes in diet and excercise, or a combination of the above following a trip to the doctor and blood glucose tests. For others, those changes will involve extensive consultation with their physician and some combination of diet and excercise and medication, including eventually the possibility of supplemental insulin. Regardless, and I can't emphasize how important this is, the persistent hyperglycemia that causes diabetes' complications responds to treatement, but to treat it, first, you have to take action to know the score.
Diabetes is a silent disease that thrives on inaction and lack of knowledge; the first step in taking back control of one's blood sugars is learning what your numbers are. Only then can you, working with your doctor, take the appropriate steps towards establishing good control.
Now, I want to say something unequivocally here...at this point, we are talking about health, health care and the very complex set of issues that surround the American health care system. I'm not a doctor or a lawyer or an expert on insurance, and even if I was, dailykos is not the place to come for medical advice or advice regarding your legal or insurance needs. I am going to leave off discussing more of the specifics here for that reason, other than to admit they are complex. If you are concerned about diabetes for yourself or someone you care about, you should start down the path of consulting with a doctor in a way that is safe for you.
I will repeat this, however: diabetes, as much as it is a disease that touches all of us, is also a disease that we can do something about.
The most powerful first step we can take is to break the silence that surrounds diabetes.
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Diabetes: breaking the silence
You know so many people with diabetes or pre-diabetes already. Not simply the famous ones like Halle Barry, Olympic Gold Medalist Gary Hall or athletes like Kris Freeman and mountaineer Will Cross, but also folks you know from high school and work. Regular, everyday people, who, one day, had to step up and face this disease. We see them everyday.
Since walking is such a gentle excercise, and since many with Type II Diabetes and pre-diabetes are overweight and can use excercise as a tool to combat high blood sugar and insulin resistance, there is a virtual brotherhood and sisterhood of diabetics and pre-diabetics who go out for morning and evening walks. After awhile, for anyone with diabetes or pre-diabetes it becomes readily apparent that you are not alone...neither alone in facing your condition...nor alone in your desire to take steady persistent action to take care of yourself.
Not simply are you not alone, but folks are using the internet in new and exciting ways to compare notes and strategies about dealing with this disease. This forum for folks interested in using carb-conscious eating is just one of many very useful places to find all sorts of information about diabetes in a supportive, non-jargon oriented environment.
Now, many reading this may have had slight suspicions that have fueled a concern about diabetes. Many of us will have a family history in this regard. Regardless of what steps you take for yourself, or on behalf of someone you care about, the important thing, if you are concerned about diabetes, is to take that first step.
That means breaking the silence. That means learning the score.
And for those of us in that 75% of the population blessed with healthy and even keel blood sugars...learning a little bit about diabetes is perhaps the most powerful thing we can do to help fight this disease.
For diabetics, and even pre-diabetics, maintaining control is a lifetime job. Our society, our political system, our work environment, and even, at times, the way we treat each other and the assumptions we make about each other...sure as heck do not make things any easier.
It shouldn't have taken my reaction to yesterday's news for me to write this diary. In the end, it did. What I'd like to leave you with, in that light, is this: there are so many hopeful stories out there, and so many reasons to have hope and optimism with this disease.
When we break the silence about diabetes, we unlock the power of that hope. That's something we can take forward today.