To be fat or not to be fat that’s a really good question

I have heard a lot recently that I am fat. I am. Didn’t used to be but things have gone from bad to worse in the last 10 years or so that are creating accumulated affects. Back in high school I was into weightlifting a lot. It helped keep me exercising and even had another benefit that I had never thought of. Years ago I read an article about insulin resistance and they said weight lifting with heavy weights can help combat insulin resistance. I don’t know the facts behind it but I can tell you from experience that if I quit lifting for more than a week my blood sugars started swinging back and forth, high and low, like Tarzan on his way to save Jane. Once I got back into lifting again it would stabilize. Due to job issues and the subsequent money issues that for some reason seem to follow them, I had to quit going to the YMCA and working out.

I can hear the next question already. Why can’t you just work out at home? I don’t have 700 pounds of weights or a hip sled or sturdy bench to use them with. Next question? Well then why not try running or biking to stay fit? From what I read in that article it does not have the same effect on insulin resistance. I did a little more digging into this and found some good reasons. Did you know that if you jog your metabolism goes up pretty high but after you stop it is back to normal in about 30-90 minutes? Lifting weight does not send your metabolism into orbit like running but it will stay elevated for 36- 72 hours. Why? Look at how weight lifting works on the body. You over strain the muscles which damages them. Yes lifting weights actually does tear muscle tissue. Now you body has to repair this damaged tissue and build it back in and this time with reinforcements to keep from happening again. It is not an over night process. It takes a few days to be back to pre-work out condition, ok better than pre work out condition.

The result of this lower standard in activity is very evident especially to me. Others who have known me for years can also see it. I never saw myself as huge or even strong. That is why I kept at it so hard. There is always someone stronger faster bigger. I had a slimmer waist. bigger arms and was way stronger than I am currently. My waist is almost 40 inches now and the stomach has Dunlop’s disease. For those of you who have never heard of this affliction it is when your stomach has “done lopped over your belt”. Can you see my hand in the air right now? Also at my peak which was only maybe 7-8 years ago I was benching 300 lbs. on the bench press and better than 800 on the hip sled. If you stuck a bench in front of me today I would be lucky to get better than maybe 160 off my chest. I am shedding a tear right now thinking about how far I’ve fallen.

The doctor has noticed my lack of exercise also.  My blood sugar graphs do a good rendition of a roller coaster on paper. Not good. Working 3 shift is not helping any. I have found myself sleeping a far different schedule than if I was working days again. Some days I get only 3-4 hours and then it catches up to me and I crash for about 10 hours. The job is only 8 hours but there is an almost 40 minute drive each way to get there and back. That 8 hour job is taking 10 hours out my life each day. Again not helping.

Of course food intake is very big factor in getting this fat. The first time I saw an endocrinologist he had me write down what I ate so he could get me back on track. He flipped out when he saw how much I was eating. I never added it up but from the amount of food listed I’d say it was around 4000 calories a day. A lot you say? I stayed at 210-220 for 10 years with that level of food consumption. I was that active. I have heard that body builders are so active that they are eating better than 5.000 calories each day. I’d have to say that at 6% body fat they are not over eating.

The reason for this little tirade this morning is an article I read that listed 2 competing theories on why people develop insulin resistance and its relationship to obesity. One says fat is caused by a hormone imbalance and the over eating and lack of exercise is not the direct cause but a symptom of the imbalance. The opponents say is from eating to many calories. A big difference is in the role insulin plays in this theory, One side says insulin suppresses appetite and the other says it amplifies appetite. Take your pick.

My personal issue with this is my own observations. It didn’t matter over the years what my weight was or whether I was buff or fat. I have always had a fat gut. Here’s the point I feel needs to be made. I have always taken the insulin in the stomach  and legs. Only places I can reach without learning to be a contortionist. That is where the fat seems to be concentrated. Again I have never been ripped like Arnold in his hay day but I was never very fat either. Why was the stomach fat so pronounced if the insulin didn’t have something to do with it?

Second class citizen

More than once I have ended up feeling like a second class citizen because of diabetes. I have heard lots of comments that lead me to believe if you have disease like diabetes you are considered broken, fragile, or flat incompetent. Just have a reaction at work sometime and watch the fall out. I have to say I am very pleased with my current employer on how they handled a recent low blood sugar incident. In the past I have been suspended, forced to get a note form a doctor to return to work, and even had an attempt to terminate my employment. That was just a rumor though (thanks to the American Disabilities Act. I have also had employers who have thought they knew better than doctors how to treat my issue such as changing my work schedule. Now any diabetic can tell you if you are having a problem with blood sugars going out of whack it is best to get into a routine and work through it. Changing things around such as work times and exercise levels is not going to help stabilize anything. Even if the doctor can make the changes to get you back on track it is for your new work life not the old one. Back in your old routine again and things will go right back were they were.

Another issue that makes me feel like I am less than normal is being told that I can not do this or be that since I am a diabetic. My first taste of this was my senior year of high school when I looked into the military. No you are classified 4F, we can’t take you. I get the no combat issue but there are so many other position in the army, navy, marines, or air force. Medical assistant, truck mechanic, aviation tech, computer programmer, networking specialist, and the list goes on. When they started letting women in the services they had been limited to non-combat roles. So diabetics are seen as less useful then a modern woman? I looked into getting a CDL license. It is not impossible but nearly so. There are so many hoops to jump through it is too easy to trip on one of them. Railroad crew? Don’t count on it. When I was given the medical test I was told my A1C was not good enough.

The bottom line here is that there are so many restrictions put on diabetics and other medically challenged people that getting a better job is very hard to do. Having a job is a good start but not much better. Things can go wrong in a hurry and with the newer pro-business congress running the law making things may get much worse. I friend once asked me why I don’t go on disability. I have never seen and will look at myself as being disabled. I can do anything that a non diabetic can do I just need to watch my blood sugars closer. They are called right to work states but that is a misnomer. It means that there is little backing for unions which in turn loosens their power. That power is needed to reign in corporations greed and power. In a right to work state, a company can eliminate your job and then open it back up with a slight title twist. Then you go to your union steward who tells you there is nothing they can do since they have no more power. In other words they can fire you for any reason and once you are gone there is little you can do to get your job back. I have re-applied at more than one previous employer only to hear again and again that since they have enough applications that they are not going to consider rehiring me. In the back of my mind I can not help but go to the idea that it is because of my history of diabetic problems. They of course can’t say that so the issue of not needing my app is used.  I do feel like a second class citizen at times. Does anyone else get that feeling?

Scapegoat or Scoundrel

Here’s my foray into the world of sensitive politics. I heard it last night at work again and over the last few years many times that people are so mad at Obama for the Affordable Care Act, the so called Obamacare. That name is false though. The bill that was actually pasted by congress and later signed by the president was not the original bill. People forget about all the arguing and political deals that were made to get it passed. Funding was cut and here just last year penalties for not meeting the mandates in it were removed. At least for businesses they were. There was talk that they would also be suspended for the people that couldn’t get insured but I looked on line and found nothing about the penalties being suspended. Hey wait, Why are the businesses being exempted but not the people who may have been banking on the supposed employer insurance? Could it possibly be the business friendly republican congress using the president as a scapegoat to make it seem the plan was flawed from the start? If you haven’t guessed yet I am very much in favor of the plan for health care to be given to everyone. As well as the cost of said plan. You may have been listening to the Supreme Court’s opinion on the tax benefits for states that use the Federal plan. If they had not backed it up and let it be defunded millions of people would have lost coverage. I read the first part of the opinion and I loved the way it was written. They could not believe that congress would have written it to cause a death spiral of insurance premiums intentionally therefore they upheld the ruling to continue funding. There are days I am not so sure anymore. The republicans have said they will do what it takes to get it repealed. There is also a rumor that once it is gone they will seek universal insurance. Last time I looked that one up we are in the very small minority. There are 36 first world countries and we are one of 3 that do not have universal health care. If you are wondering It’s not just Canada that carries this Britain, France, Norway, Sweden, Cuba are just few I know off the top of my head. How long you ask, Norway I believe started just after WW2. That is 70 years of testing get over it. It is also a good side note here that the USA life span is shorter than most of these places. People tend to go see a doctor sooner for problems if the cost is not astronomical. OK back to the Affordable Care Act. I never was able to get a personal policy because of pre-existing condition clauses. I now have a huge medical bill because I had an employer insurance that had a pre-existing condition clause written into it, pre ACA I am sure. That was also a legal way around the ACA and many insurance companies took advantage of it from my understanding and renegotiated the policies before the law hit. Because I lost my insurance from my last employer before getting my current job, I lost the ability to continue coverage for my diabetes. The entire first year the costs were astounding. Each visit to the doctor, every 3 months, was about $250, Lab test were on top of that about $110. The insulin and pump supplies were much worse. The insulin was $220 a bottle with a new bottle every 9 days roughly. The pump supplies were $131 each month. The pump payments were also $131 each month. Let’s see what we are up to now. $220 times 4 weeks (it was just over one week that the bottle would be empty) is $880 plus $131 is now $1,011. Add in the pump payment each month and now we reach $1,142. The doctor visits are only every 3 months so divide that total by 3 and we get another $120 each month for a grand total each month of $1,262. At least I was working overtime then. Without it I would not have been able to afford just he medicine. Scary? I have heard of others who fall into this category even farther where insurance companies are slipping through the cracks created by all the knit picking in congress and leaving Americans uncovered and unprotected from the extreme cost of health care in this country. Here’s more food for thought, ideas that have crossed my mind over the last few months. If they repeal the Affordable Care Act how long before millions of Americans lose coverage for the now covered pre-existing conditions. Did you injure your knee in a high school football game? They could deny it as a pre-existing condition. Are you getting meds for high blood pressure? Don’t change jobs because it is now a pre-existing condition? No way you think. Why would a company miss a chance to save money? I had a foot pain last year and went to see the doctor because it hurt so bad I was having trouble walking. Lis Franc fracture was what he said. It happens in diabetics. That went on his report that was sent to the insurance company. Result was the X-ray, CAT scan, and MRI were denied due to pre-existing condition since it was related to my diabetes. It was not a new injury and I argued with the insurance company that this was not new. I had never had an issue with my foot before. I was told as long as it was shown to be related to my diabetes it was denied  Here’s my thing on this, we need to get rid of all these loop holes and back doors for coverage. You should be covered period. I’m not saying they need to pay for a chin lift or tummy tuck but a possible broken foot? Come on. The Affordable Care Act was supposed to be designed to fix problems like this not create them. It is over 2,400 pages long. I have it saved on a flash drive. I have not read the whole thing yet but I reference it every now and then. Wow 2,400 pages of hitherto and therefore. The last book in the Harry Potter series was only 759 pages. Image reading it 3 times.

Well I’m going to slink off in the corner after upsetting a lot of people with this blog entry. Hey it is my take on things and my opinions. Feel free to disagree with anything or everything I have said. I just hope it makes people think about where our health care is really at today.

Complications anyone?

I just read a blog from a fellow type one and found that although I have been far from blessed I do not have the terrible effects that some other diabetics have had. Mine are simple but none the less tend to cramp my style.

Retinopathy? Yes I have it the left eye. Had it in the left eye. I would describe the procedure but having people faint and be terrified of getting it fixed later would not be good. It was done in three waves so as to not over load the eye with trauma. Basically they used a laser to burn any small, unwanted, weak blood vessels and I ended up with a one way ticket to a pan retinal photo coagulation. Quite the mouthful. The entire retina except the macula (this is where something like 80% of your acute vision come from) above the optic nerve was lasered. They deaden the eye which can give you some awesome play time later. You can’t move the eye, you can see anything with it, and you need to keep it protected because of this. The laser was so bright and in close enough proximity to the right eye that it actually hurt to keep that eye open, not bad but like staring at the sun. They say to keep the patch on for at least 3-4 hours and be mindful of the double vision. They aren’t kidding. I watched TV for almost an hour right in front of me and then about 5 feet to the left. Yes five feet. The second time I took the patch off in the bathroom so I could see what was going on. Sweet! Shaking my head side to side my left eye ball would continue in that direction since it was still paralyzed. Well of course it was repeated the third time, are you kidding? This was the coolest thing to watch. Ha, ha, ha.

Peripheral nerve pain? I have to say no to this. In fact I have to say that I feel my feeling in my hands and feet is as good if not better than a “normal” person’s. At the YMCA, when I could still afford to go, I could feel the sand on the bottom of the whirlpool (they had sand filters). I am always getting scrapes, scratches, and other boo boos. Most I feel but there are some of those that are mystery wounds. I do have an extremely high pain tolerance. I dislocated my shoulder but worked for 3 and half years before it was really figured out and fixed. No, no, no it slid out and back in that day. 3 times mind you but I was not walking around with misplaced shoulder all those years. And as a testament to not being a slow healer, they said I would be at least 3 months before returning to work, maybe as long as 6. Very proud to say it was only 2 1/2 months before they released me back onto my employer. I just talked about how sensitive my feet are but I have stepped on a nail that impaled it bottom to top. I just limped into the house pulled the shoe off and mom made me go get a tetanus shot. That hurt worse than the nail in the metatarsals.

 

Memory? I think my memory is good, I didn’t say perfect. I can remember things pretty well day to day and decade to decade. What was I just talking about? Oh yeah.

 

List Franc Fracture? Here’s one to look up when your bored. I never heard of it before the doctor told me it was what he thought I had. There was one catch to this diagnosis. He says it is a common thing for diabetics to get. I can not find anything on line about it being a diabetic complication. Here’s the low down on this one. This is when the bones high up in the foot are pulled apart and dislocated. Yes like the shoulder. It is also called a dislocation fracture although no bones are actually broken. They ran every test they could. X-ray, CAT scan, and an MRI all to no avail as there was nothing but arthritis showing on any of them. Hey I was 45 when this happened, not just over the hill but half way back under it again.

As far as anything else, I have never let the fact that I am a diabetic stop me from doing anything a “normal” person would do. Body piercing, eating all kinds of foods not diabetic related, just not pigeon holing myself into a stereo type. I had at one time used a pump but found it too cumbersome and problematic for me. Now if I go to the beach I can jump  in the water without worrying about getting an infection at the infusion site (done that one already just not with water) or getting the infusion port ripped off and being left with no insulin until I get home (again been there done this). The pump is wonderful don’t get me wrong but it is not for everyone and I am that everyone.

 

Prone to infections? Well my doctor will give you quick and hearty “YES!” I am not so quick in my answer. If he only knew how many times I have been opened up and who knows what germs have gotten in there with no complications. I do have to say on the other hand I know why he is so, ahhhhhhh, judgmental here. I have almost died from two massive systemic infections. One he told me years later he had not expected to see me again after sending me straight to the hospital. Remember that piercing I was talking about. Yeah, it did not go well the first time around. I love the TV show NCIS: New Orleans with Agent King’s famous words “Go learn things.” Whenever I have made a mistake, I learn from it. I found later I had been using the wrong soap. Antibacterial hand soap is not good enough. You need to use surgical soap. So I did it again months later after the original hole has healed and this one was a success. The other infection was after getting bit at work. No not the neighbors dog, a human bite. One of the most infectious bites you can get. It ranks right up there with a Kamodo Dragon bite. I was bit on the forearm Saturday afternoon and ended up in the hospital Monday night after work. I was not going to leave them short handed. Fever and all I stuck it out. I saw the redness in a maybe 4 inch circle around the bite and was very surprised and little scared as the doctor drew a marker line up just a few inches from my shoulder. Holy infections Batman! It took some really good antibiotics (two of them) to get rid of this one. The one wasn’t so bad the other one made it feel like I ants UNDER the skin all over my upper body. Well two days later I was released back again onto my employer, poor people.

These are about all I can think of for complications or usual diabetic complications. After reading about other who have had a much worse time with more and more devastating issues, folks my hat is off to you.

What’s it like to have a reaction?

The plan here is to relate what it feels like; what is going through a person’s mind when they have an insulin reaction. Mind you this will be only my point of view and experiences. Probably the biggest question people give me is, did you eat. Well yes I did. I have pointed out in a previous blog that this is a three way balancing act. Maybe I worked a little harder than normal. Maybe I was stressed out about something. Yes stress affects a person’s blood sugar. Maybe I am sick that day. Running a fever burns more carbs just like exercise. It is always possible I miscalculated the dosage for my insulin or miscalculated the amount of cabs I am eating. As I said there are probably hundreds of reasons for a low sugar. The most common, for me at least, is increased exercise. If something happens at work and causes me more work it throws any previous planning out the door. Wait isn’t that one of three balance areas for blood sugar? Well what do you know. When the low sugar starts to hit confusion is the first sign for me. In past jobs I have found that having a low stimulus environment is not a good place for me. Without stimulus to concentrate on I don’t always notice when my sugar level drops. Am I just tired at this point? It could be. Something to keep in mind at this point is my mind is not working at full capacity. Some would say that isn’t much to start with. Thinking rationally isn’t always an option. I am currently working third shift so being tired is pretty much an occupational hazard. Heat makes it worse. Oh yeah, it’s summer now. Now that I am feeling tired and confused what do I do? At work, stopping to spend 5 minutes checking my sugar level isn’t always going to work. Things need to get done and if I can’t they will replace me with someone who can. I simply grab my high sugar pop (grape or orange soda are my favorites) or I will grab my bag of Skittles. At this point my doctor is going into cardiac arrest. This is not what they want you to do or tell you to do. I have tried the glucose tabs but after eating the entire container I still had to get more sugar. A small bag of Skittles is 56 grams of cabs most of it sugar. Think of them as sugar pills. The part I like best about them is they are scalable. I don’t have to down the entire bag. I can eat a small hand full and see how that works before eating any more. The soda are not as forgiving Once they are opened you are going to drink the whole thing. Those are about 44-46 grams each can. They are quick but not as quick as Skittles. Here is a lesson on how blood flows in the head. Ever hear of placing a nitroglycerin tablet under the tongue? There are quite few very small blood vessels under the tongue and they infuse the nitro into the blood stream very fast. Catch on yet? When eating the Skittles, I do not just chew fast and swallow. I chew and chew and chew until I feel it has been long enough. This works the sugars out of the candy and under the tongue, where it gets into the blood stream faster. The soda just gets swished through the mouth and into the stomach where it takes longer to get into the blood stream. Think about it. If it was faster to get it into the system through the stomach why place the tablet under the tongue? That is how it normally feels to have a reaction. I can feel it coming and have the time to treat it. There are times however that it is too fast to stop or it happens while I am sleeping. When I first started using a pump this was a bad time for me. I was working second shift then so sleep was actually at night. The first week I had EMS waking me up 5 times. I went from 1.8 units per hours down to I think about .25 units per hour. Now I quit using the pump and am back on 24 hour insulin shots. Here recently I had a reaction at work and it was fast. I felt it coming on and got off the fork truck and made the mistake of believing I had time to wash my hands before getting anything out of machines. Remember how I said rational thinking goes out the window when the blood sugar drops? They found me collapsed over the wash sink in the bathroom. How low was it? They gave me a can Mug Root Beer so I don’t know how much was in it but I’d guess its at least 40 grams. Plus they gave me a bag of Skittles on top of that. A normal meal for me is about 60 to 80 grams of carbs. This was close to if not over 100 grams. I can’t say how long before the EMS got there but I’m sure it was not more than maybe 10 minutes. That is not long enough for much sugar to get into my system, sub-lingual or not. This brings to light another issue. Untrained and even some trained people will keep feeding you sugar to get it up when you just need to wait. It takes time to absorb sugar. Feeding a person twice as much as they need will not speed this up. I have topped out at more than 400 after EMS kept feeding me trying to get it up faster. Doesn’t work like that folks. When they checked my blood sugar that morning  it was 84. This brings up another issue I have heard about but can not find anything online about. Does how fast it drops factor in as much as how far it drops when showing signs of low blood sugar? I once heard someone on TV say that the speed of the drop is as important as how far. I have had a blood sugar of 24 and was able to tell the nurse in the hospital not only who I was and what my address was but how to get there from the hospital. She could not believe the test so she ran it again after they started the IV and it was 26 in the other arm. I have held conversations with people when my blood sugar was only in the 40s -50s. Testing at night has found the same to be true. I have felt the symptoms of low blood sugars when testing shows it in the high 80s. So to answer the question asked so many times over the years, yes I can tell but not always do I have the time or do I think rationally to prevent it from getting worse. Anyone else have any insight or experiences with low blood sugars?