Diabetes is not the end of the world.  My brief history with this disease.

My Odyssey Begins

I was having a routine physical on Saturday, March 27, 2003 and the med-tech said, "Hmmm!  There's sugar in your urine.  I bet you're diabetic!"  And sure enough, the blood test results that came back a couple of weeks later showed that I was.

Diabetes is indicated if a random blood glucose test shows higher than 200 milligrams of glucose per deciliter of blood.  My "score" was 236.  A second test called the glycosylated hemoglobin or  Hb A1c was conducted that day.  It indicates the level of blood glucose over the last 60 to 90 days.  A normal score is less than 6.0.  Mine was 10.0, which roughly shows an average blood glucose of 275 mg/dl.  Although I hadn't seen a doctor with results in hand yet, the diagnosis was going to be obvious:  I had diabetes.

Leesa and I were in the process of moving to New Orleans from Dallas and this might have proven fortuitous.  Instead of going to the family doctor in Grapevine, I decided to find a doctor in New Orleans and start my treatment there.  Some research found a good match:  An Internist, board certified in Endocrinology, covered by our insurance, who was willing to serve as my primary care physician and who has diabetes himself.  I made an appointment with Dr. Miguel Rivera for the first available appointment on Thursday, May 8, 2003.

In the meantime I took advantage of one of the biggest benefits of working for Sodexho -- a huge selection of Registered Dieticians on staff.  They took a look at the results and all of them had a slew of ideas:

1. Start monitoring my blood glucose immediately so I can start to learn how diet and exercise affect my blood glucose.  There were lots of recommendations on meter brands, but I ultimately selected a OneTouch UltraSmart by LifeScan, a Johnson & Johnson company.  I chose this brand and model because of the built in logging functions and the software, which was available for free directly from LifeScan.
2. Start eating fewer carbohydrates immediately.  This caused much discussion among my RD friends over lunch as they debated the "right" amount of carbs for me.  The suggestions ranged from the American Diabetes Association's recommendation of 50% to 60% of my calories from carbohydrates to an Atkins Diet clone by diabetes treatment pioneer and Type 1 diabetic Dr. Richard Bernstein, allowing a total of 30 grams of carbohydrate per day!  They settled on 40% or less of my total calories coming from carbohydrates with the understanding that we would reevaluate weekly (!) based on my blood glucose readings.
3. A goal of 110 mg/dl blood glucose before meals and no more than 120 mg/dl two hours after I begin a meal.
4. Continue my exercise program.  I ride my bike regularly and have for years, so I was relieved that I wouldn't have to change that regime.
5. Lose twenty pounds.
6. Start reading up on the disease.  Some of the recommended books are down at the bottom of the page.

So, on Saturday, April 19, 2003, I began testing.  My first day was discouraging, with scores as high as 350 ml/dl!  However, I quickly got the hang of exactly how much carbohydrates were affecting my blood glucose and started to rapidly bring down my numbers.  By the time of my appointment with Dr. Rivera, I had readings that looked almost normal.  Normal aside from the mornings, which were continuing to give me spikes as high as 176 ml/dl.

The visit with Dr. Rivera was almost an anti-climax.  He was able to confirm the diagnosis that I had diabetes, gave me a complete physical, did a good job educating me on some of the "bad" things that would happen if I didn't stay on top of it and gave me a few prescriptions for me to try for the next six weeks.  He also said that I had probably had diabetes for seven years or so (which surprised me, as I had physicals which I thought would have uncovered it).

Reading the books, I had paid very careful attention to some of the "bad" things such as neuropathy (loss of sensation that frequently results in amputation of the feet), retinopathy (disorders of the eye that frequently result in blindness), etc.  These gory details had my attention.  However, I had missed out on the substantially increased risk of heart disease.  So, I was surprised when my prescription list included:

1. Metaglip (glipizide and metformin HCl) 2.5 mg/500 mg once daily, which is a combination drug that increases insulin production and allows the body to use the insulin that is produced better.
2. Pravachol (pravastatin sodium) 40 mg once daily, a statin which is used to lower my cholesterol and reduce my chance of heart disease.
3. Altace (ramipril) 5mg once daily, an ACE Inhibitor to lower my blood pressure and protect my kidneys.
4. An 81 mg aspirin once daily to thin my blood.
5. Enough strips to test six to eight times a day.
6. A referral to a Certified Diabetes Educator.  Might as well, since insurance would pay for it, though I was more than happy with my "team" at the office.
7. Advice to not follow the ADA's recommended diet.  Although he did not specify a specific carbohydrate target, he did say that I would not be able to meet the goals unless I used a target lower than the ADA's.

Armed with my prescriptions, I began the therapy immediately.  The difference in my scores was slight, but almost all of my morning readings were below 110 mg/dl and my average was 104 mg/dl.

From my research on the internet, my results do not look typical (and in any event, they are over such a short period of time that they're probably meaningless anyway).  However, I do think I have a few advantages:

1. I know a carbohydrate when I see it and I am able to "eat to the meter."  If the meter says that my blood glucose is higher than I want, my meals will be low in carbohydrate until I get to where I want to be.  If I'm below my target, I will add in some carbohydrates.  My carbohydrate consumption appears to be about 30% of my total calorie intake.
2. I am active and have been active for years.  I enjoy endurance bicycling and have done it for a long time.  In fact, some of the same dieticians who now help me keep my carbohydrates low are the ones who helped me design a diet high in carbohydrates for the multi-hour events that I participate in.  Now, we're trying to redesign the diet without such treats as the massive pasta dinners the night before events and the huge amounts of PowerAde that I would drink on the rides.  In the old days, the idea was to keep my tank full of glucose, but today, we have to put in "just enough."
3. We discovered the disease early and my numbers are not really too difficult to control today with diet an exercise today -- though I am told that this might get worse over time.

With all of this supposed "good news" one wonders how I got so "lucky" to get diabetes in the first place.  Well, it turns out that it runs in my family, though neither parent has it and nobody bothered to mention the other family members who have it until I spoke up.

Results Tracking

Here are my results from each exam.  The ADA Targets are provided by a position statement from the ADA themselves.  My Targets are derived from various research studies but have a strong basis in the Medical Guidelines for the Management of Diabetes Mellitus provided by the American Association of Clinical Endocrinologists.  I have linked directly to the studies where appropriate.

Research

If you want to learn more about diabetes, your first stop on the internet should be at Rick Mendosa's site.  Rick is a freelance medical writer and consultant on the subject and has links to almost every imaginable site.  The content is fresh and gives excellent advice and information.

Discussion

If you want to talk diabetes, may I suggest you visit the alt.support.diabetes newsgroup.  Newsgroups are a fun way to learn more about the disease and find out what other people are thinking.  It's a way to get instant advice & feedback, but be aware that the content isn't censored and is fairly anonymous.  Don't take anything you read there personally.  Also, remember that this is in NO WAY close to medical advice, so please apply your common sense to whatever you read.

Bibliography

If you would like to find out more about the books, videos and CDs that I reference on these pages, you can do so here through an arrangement we have with Amazon.com.  These references will take you to Amazon.com's stacks and you can find out more about the source of the book, video or CD, reviews from readers, viewers & listeners as well as availability and links to other books, videos or CDs with similar titles, subjects and authors.  You can also leave your comments on each of the works!

First Year Type 2 Diabetes: An Essential Guide for the Newly Diagnosed, The, Gretchen Becker, 2001.
I think this is the essential first read for the newly diagnosed diabetic.  Becker does an excellent job of walking the new patient and his family through all of the bits and pieces that you simply must know to successfully manage this disease.
Dr. Bernstein's Diabetes Solution. Dr. Richard Bernstein, 2003.
Dr. Bernstein has a revised edition of his classic book and I found it to be a fascinating read, even when I don't completely agree with him.  Bernstein created the revolution in blood glucose monitoring and even became a doctor at forty-five so that the medical establishment would listen to his hypotheses.  Bernstein is an advocate of a very low carbohydrate diet (lower than even Atkins in some instances) and I think he gets a little bit of a bad rap because of this.