My Introduction to Diabetes

Foot fractures, ulcers, neuropathy and Charcot are not unique to diabetes. They are also not the only serious complications associated with the disease. In addition to foot problems, diabetes is a principal cause of kidney failure, high blood pressure, muscle fatigue, heart disease, stroke and loss of vision. Given my forty-year struggle with the disease, I am relatively fortunate. In addition to the problems that have threatened the loss of my left foot, I have Stage III (moderate) kidney disease, but have been spared serious heart and vision problems. My kidney function and condition of my feet were normal before I became diabetic. Both conditions worsened during the period that I recklessly failed to acknowledge the seriousness of the disease. However, as I discuss in later installments of my blog, over the last ten years, my kidney function stabilized and the incidence and severity of my foot problems improved through a combination of diligent glucose monitoring, comprehensive medical treatment and advanced technology. Had I continued along the path I had followed earlier, I would almost certainly be footless, on dialysis and possibly blind or -- worse, dead. My effort to help my readers preserve their limbs and avoid the other vicious complications of diabetes necessarily begins with a discussion of my experiences with the disease itself.

Diabetes Defined

There are two types of diabetes: Type I, sometimes referred to as “childhood” diabetes, and Type II, or “adult-onset” diabetes”. Broadly speaking, Type I diabetes is an autoimmune disease that is characterized by the inability of the pancreas to produce insulin in sufficient quantities to convert sugar to energy, while Type II is a disease in which excess body fat, poor diet, inadequate exercise and age interfere with the ability of the body’s cells to process the insulin the pancreas produces. Type I generally requires injections of insulin to replace the body’s natural production, while Type II can often be controlled with dietary changes, weight loss, increased activity and various oral medication. In severe cases, insulin injections may also be necessary. The causes of Type I diabetes have not been firmly determined but are thought to result from both genetic and environmental factors and/or a virus.

My Life Before Diabetes

I was a chubby kid and loved to eat. (That hasn’t changed). My first thirty-six years were marked by a repeated sequence of heavy eating and binge dieting. See a pizza, devour it! See an attractive girl, diet! My dieting was uniformly motivated by vanity rather than health. My life in athletics was likewise wanting. My caring parents tried to interest me in athletics, to no avail: swimming, boxing, little league baseball, even Judo. (Judo was short-lived. At age eight, I threw my father across the living room and sprained his back). My parents then sent me to an athletic day camp. My only “A” was in eating lunch. Really!
When I entered high school, I was 220 pounds. I stopped eating and lost 40 pounds. By the time I graduated, I was back to 220. When I was 26, I topped out at 308 pounds. I went to a “bariatric specialist”, who gave me daily injections of human chorionic gonadatropin (“HCG”, since banned by the FDA) derived from the urine of pregnant women. The injections, along with a 600 calorie/day diet consisting of a three-ounce portion of boiled chicken or fish and an undressed salad twice daily, enabled me to lose 140 pounds in six months. After fluctuating within a 20 to 30-pound range over a ten-year period, I crept back to 240. I enrolled in a hospital-supervised “protein sparing” fast, consisting of six 100-calorie protein powder shakes a day, weekly blood tests and group “behavioral modification” sessions. The week before I started, I noticed that I was consuming large amounts of water, followed by excessive urination: unbeknownst to me at the time, a common symptom and precursor of diabetes. During my first visit to the weight clinic, the doctor casually told me that he assumed I was on the diet to treat my diabetes. Diabetes?!! What diabetes??! My blood sugar registered 306 (normal is 80-110).

Prior to age 36, my health was generally unremarkable and periodic blood glucose readings were normal. Alarmed by the diagnosis, I promptly consulted with my internist. Given my biological age, weighty eating habits and athletic deficiencies, he concluded that I had Type II diabetes. He suggested that I remain on the weight loss program and monitor my blood glucose. After three months and a 25-pound loss, my glucose levels returned to normal. Unfortunately, the success was short-lived. A few months later, my glucose readings spiked. The doctor prescribed Metformin, a still-used diabetic control medication invented in 1922. The medication failed to work. I consulted an endocrinologist, who reviewed my history and concluded that I was a (late-blooming, I guess) Type I diabetic. (He referred to the brief period that my blood sugars were normal following the diet as a “honeymoon period”, a common but fleeting condition following rapid weight loss at the onset of diabetes). Interestingly, there is no history of the disease in my family and no doctor has ever been able to account for why I got it. Although it is uninformed by anything I have heard or read on the subject, my theory is that my protracted history of binge eating and starvation diets taxed my pancreas to the point that it was no longer able to produce insulin.

Next time: Careless behavior produces bad outcomes

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