Friday, March 2, 2007

The Future of Diabetes

This is a question I've read on other blogs: What is going to happen to us? What is our life going to be like?

Assume there isn't a cure coming out in the next 10, 20, 30 years (I know, I know). Assume that you're going to be diabetic until the day you die. What's going to happen to us? "Us" meaning the people diagnosed with diabetes in the current era of diabetes management - daily self monitoring and self adjustment, carb counting, continuous glucose monitoring systems, pumps, and regular endocrinologist appointments. What is our life expectancy? Are we going to lose our eyes and feet even if our A1Cs are under 7?

I started thinking about this yesterday when yet another woman on Diabetic Mommy was the victim of a side-comment from a nurse that ended up being incredibly scary and / or hurtful. Her A1C was 6.9, and on her forms the nurse marked "uncontrolled diabetic" and then said that it made sense to her, looking at the readings downloaded from the woman's blood sugar monitor.

Hold up now. What the hey? I'm the queen of spinoffs, so I'll try and stop myself before I get off on a tangent. . . but isn't an A1C of under 7.0 considered pretty damn good, according to the ADA? Your body makes no insulin. Unless you want to spend your days eating the same meal, at the same time, and pretend like you live in a vacuum with no emotional upsets, exercise, stresses to the body or mind in any way . . . crap, even that won't work. A Type I diabetic is going to have major blood sugar flucuations NO. MATTER. WHAT. She is busting her ass, testing like crazy, and doing everything as best she can. So what is this "uncontrolled" garbage? How about having a box on the form that says "This disease sucks ass; all things considered she is doing very well." Then the other box can say "This disease sucks ass; patient doesn't give a hell and walked in with a jumbo-sized Pixie Stix."

I guess that box on the form hints at the fact that the ADA may very well be full of caca-poopy. How do they know that an A1C of under 7.0 guarantees long life? What if the only way to escape DEATH BY DIABETES is uh, if you aren't diabetic? (And let's not even get into the "the A1C is not a good indicator of overall control" discussion.)

The word on the streets right now is that no one really knows what's gonna happen to us "kids" working to keep our A1Cs under the magical threshold. All the studies on what creates complications are based off of the older diabetes models and patients. The whole culture and feeilng surrounding diabetes is best summed up by those magazines I receive from my insurance company in the mail . . . some cheap, thin rag with a retired gentleman walking his dog on the cover, and the same tired "information" inside. Are you testing your blood sugar regularly? (I could cut glass with these finger calluses.) Do you know the symptoms of hypoglycemia? (Rattle n roll, tootz.) A yummy meal plan for you! (Wow, fat free imitation butter spread AGAIN? Shocker.)

Is 6.9 good enough? Is 6.8 (my last one, in January) good enough? Is 6.2 (my 2nd-to-last one, in September) good enough? Is anything we do good enough, or are the complications inevitable?

I guess I'm also curious at what a typical A1C is for people who are "controlled" - I mean people who test more than 4 times a day, count carbs every time they put something into their mouths, and think they have a pretty good handle on basal rates and bolus ratios. I think my view of this is a little skewed since I'm a regular DM visitor, where the ladies have some of the most stellar blood sugar records around (babies have a way of motivating like nothing else). It's easy to feel "out of control" there when your two hour post prandial reading is - gasp - 140 or your A1C rockets off the charts at 6.5+.

No comments: