“Every artist was first an amateur.” –Ralph Waldo Emerson

From the genius mind of  Lee Ann Thill of the Butternut compartment, (she is the beautiful lady in the at the beginning of my piece) came the idea of Diabetes art day.

My piece is called Random Diabetes

Diabetics come in all shapes and sizes, you could be sitting next to one reading this blog and not know about it. So as random as we all are, we are a force of nature that cannot be messed with.

thanks to my tweeps @thepoordiabetic for being such great muses.

Am not a doctor, I just play one on TV

I am drawn to the puzzled expression on Sam’s face, he is sitting in the Endocrinologist’s lobby with a box of lancets in his hand. A few minutes earlier as I walked into the exam room for my regular check up he had the same puzzled expression on his face only this time it was much deeper, the furrows above his eyes screaming ” and what the hell am I supposed to do with this”.

Sam’s story might not be unique except it just happened to coincide with one of my worst Endocrinology visits in recent years.

You see Sam had joined a select group of about 24 million others with his brand new diabetes diagnosis and at this particular time, no thanks to the Endocrinologist, he was at a loss on what to do next.

For in all her might and glory, all she had said was simply this.

“ Sam you have type 2 diabetes, am sure you have heard about it. I will put you on a Drug called Metformin to control your blood sugar and have you talk to a dietitian about changes in your diet and you need to exercise, I am including a prescription for your blood glucose meter which you will need to check your blood Glucose levels on a daily basis and I suggest you get on the Internet and learn all you can about diabetes”.

The bad news handed in a matter of fact way left Sam shocked and speechless, and without a single question, he faltered towards the pharmacy to get his bag of goodies.

The Items in the bag as alien as the diagnosis itself, the surreal environment and the clueless thoughts  of what lay ahead was the man I saw as I was walking out of my own nightmarish episode of a visit.

Sam Looked over and said to me, “I couldn’t help but overhear, your visit in there, but my Name is Sam and I have just been diagnosed with diabetes, do you mind if I ask you a few questions”?

As much as I was steamed, I just couldn’t walk away, I knew that puzzled expression would haunt me if I did not at least give him a crash course in diabetes ABC’s.

Our conversation naturally started with the why.

• Sam was not over weight, he did have a history of diabetes in his family and while he didn’t exercise much, his diet was not bad enough to warrant diabetes he said to me.
• I tried to explain the risk factors  and some of the mitigating factors for a diabetes diagnosis.
• I assured him that it wasn’t his fault or anything he did to warrant it.
• There was no diabetes cure regardless of what he would come across on the web.
• Expectations Included both high and low days, there wasn’t a cookie cutter solution to diabetes management, Effective day to day management would facilitate better long term a1c numbers.
• Change in diet, limiting carbohydrates and experimenting on different foods before he added them.
• Benefits of exercising even if It was just walking for 30 minutes everyday.
• Those lancets and how to use a blood glucose meter.
• Last but not least finding the right Endocrinologist which we both felt was obviously necessary in our cases.

I have mixed feelings when it comes to the medical profession because of some deep rooted experiences I had growing up, both my parents are in this profession, My old man and younger brother are  doctors, my mom is a nurse and pretty much 80-90% of my extended family are either doctors, nurses or clinical officers.

I still believe that Healing is  the highest form of a calling and those that practice it  should be treated like rock stars. That having been said, I also believe Bed side etiquette should be a make  or break course in medical school.

Maybe it was because Sam was a pro Bono case that the practice takes in or maybe this Endocrinologist was having a bad day, or she was overworked, these are valid reasons for the way we both were treated on this particular day.

The sad part is, as much as Sam felt rushed and tossed to the wolves he had no insurance which meant no choice but to keep coming back for the free but critical health care he needed now. I am assuming the practice is looking to fill in Dr. K’s spot so hopefully the new Endo will have a better bed side manner, as for me I am quietly shopping for a replacement.

Yesterday I went to see my Endocrinologist for my regular six month checkup. Now this last cycle has been tough for me, trending fasting highs especially has been a contentious issue.

It all started a couple of months back when my Endocrinologist switched my Metformin prescription, Maybe as Karen of the Bitter-Sweet Diabetes Blog aptly put it, I have just been lying to myself and trying to deflect my lax in management but  I swear, I can  trace my precipitous fall to that particular Metformin prescription.

My regular Endocrinologist was not overly concerned when I phoned him about it last month and we formulated a plan of attack to get me back on the horse, Including targeting my fasting sugars, by using wine. I thought we were in good shape until I walked into the endocrinologist and all hell broke loose.(Maybe it was a bad batch or just a different manufacturer but it simply wasn’t working for me.)

I was ushered into the waiting area as usual, and as I was walking in there was this older guy maybe in his late 50′s, I will call Sam (Sam didn’t want me to use his real name). We make eye contact as I walked by and I could see Sam was somewhat distressed but more on Sam later.

I get into the cubicle and the nurse comes in to do the usual checks. Weight 190 (pat in the back, I am 5 pounds lighter than last visit), BP 190/85, so for a moment I was feeling good about myself until she looked at some notes on my chart and goes “Geez I see you had some major problems last time you were here, did someone contact you about these test results?”, Instantly I am sweating bullets coz I think something was seriously wrong and no one bothered to tell me about it.

Curiously I tell her that I had talked to Dr. K but he did not seem concerned about anything, well I will let you talk to the new Endocrinologist when you see her.

Her?? Wait a minute, where is Dr.K ?  Dr. k is no longer at this practice, he moved back to Chicago to Join his Father’s practice she said nonchalantly as she walked away.

Damn he never even said goodbye quipped the heartbroken me. Damn, we had built such a rapport Dr. K and I and suddenly I was reeling from the impact of a jilted one.

The New Endocrinologist walks in and she is Indian, now the only reason I am mentioning her nationality was because  there was definitely a language barrier and a not so subtle bristled bed side manner when we got down to the  gritty.

Endocrinologist:  Hey Ronn how are we doing today? Good did you check your sugars this morning?

Me: Sure I do I check them a couple of times a day

Endocrinologist: What were they?

Me: Sheepishly my fasting was 235

Endocrinologist: Yikes that is very high, do you not have any control of your glucose at all, when was your diagnosis?

Me: 1997 and yes I do have control but lately I have been having a problem which started with this Metformin script I got a few months back and I have been fighting to get back ever since.

Endocrinologist:  Ronn  your sugars are not in control at all

Me: Now wait a minute Doc, I don’t Intend to disagree but this is merely a hiccup not the sky is falling.

Endocrinologist: I don’t know what you are doing but it seems we need to go back to the basics, I am making you an appointment with the dietitian if you need help with your diet.

Me: Doc I have been a diabetic for 13 years now I am pretty sure I know something about what is expected of me.

Endocrinologist: Well from what I am seeing, you are very much non compliant.

Do you know your sugars were 300 last time you were here.

Me: Yes I know I had Dr. K run the test last month to show how infective the Metformin was at the time. He tested me an hour after I took the Metformin that morning and I was still at  that number, so we formulated a plan that seems to be working during the day but I am still having a problem with my fasting sugars, didn’t Dr. K put that in the notes.

Endocrinologist: No Dr. K’s notes are not up to date but his and your idea of control is not adequate, do you know your a1c jumped a % point this time around.

Me: Well doc if you check my history, you will see that this is the only cycle that I have been trending upwards and I am at loss too, my diet has not changed much and I still exercise pretty frequently and its only been about a month since we started working on this plan.

Endocrinologist: Control means all the aspects have to work together if one doesn’t work then nothing will, its been long enough so whatever you and your previous Endocrinologist were doing to adjust obviously is not working.

Me: So what do you suggest we do doctor New expert Endocrinologist

Endocrinologist: I am going to double your Metformin for now and we need to do a follow up in 4 weeks to see how effective that is then we will go from there.

I am just doing my job on your health Ronn so I am not going to sugar coat it and I still want you to see that dietitian.

Me: Sure Doc but my problem is just in the mornings most days it will be back to normal by the end of the day.

Endocrinologist: Ok so how about we start with 500mg Metformin in the morning and  1000mg @ night.

Me: Ok we can do that and I will see you again in 4 weeks.

Endocrinologist: Sure Ronn, I will also need you to take a blood and urine test so hang in the lobby while we set that up.

Me: Thanks Doc

I head to the lobby muttering stupid Endocrinologist, thinks I am an Idiot under my breath.

There is Sam sitting with a Bag of goodies and still has that  puzzled look on his face, I couldn’t help but overhear that you are a diabetic,  he says to me. I have just been diagnosed, do you mind if I ask a you few questions…..

More on Sam’s story tomorrow

My Kingdom is in turmoil, my closest  are plotting against me, spies are everywhere and I have little recourse  but to hunt down those who usurp my authority, it is a time of profound upheaval in this once peaceful nation. Establishing my  mighty rule is becoming  difficult for I have grown from the immortal world greatest dad to a mere mortal.

The William Wallace of this merry band of misfits is non other than Ronnie Jr.

No This isn’t the plot to Brave Heart and am not Edward I of England but inside these 4 walls of the  1200 foot tiny kingdom of Ronnapolis I am the undisputed king.

So I am a little  vexed when the crown prince decided he is the incarnation of  J. Edgar Hoover in a Jr diabetes cop uniform.

It is my fault I suppose for teaching and encouraging him to follow a path to healthier living.

The Diabetes police do not invoke loving feelings from the PWD for they are the Nazi’s in the family even though their methods come from a loving place.

But as much as it irks me sometimes, I could not be any prouder that the son has become a Jr Diabetes Cop.

It simply means that he is embracing  the healthy kids healthy weight program and he is absorbing most of our label reading, portions, carb counting  and other diabetes diet related aspects that I have him observe.

With the Great News last week that he is not pre diabetic, our focus has now shifted to weightloss and healthier diet alternatives.

My diabetic diet is strict enough that I have to allow for a cheat dish once a week. Mostly it has been a desert, the sugar free fat free ice cream is a  favorite.

Last week I was having a discussion on the side effect of the artificial sweeteners found in most sugar free foods, Sorbitol in particular and he must have been listening to the conversation so lo and behold when I went to get my desert he got out his Diabetes police hat and started teaching me on the dangers of artificial sweeteners. From my conversation, he had gone online and researched them.

I got the Sorbitol side effects speech from the diarrhea, to skin rash to extreme weightloss to abdominal bloating, in addition to the fact that my serving was actually adding about 30 grams of unnecessary carbs to my day.

Needless to say now I have to find another cheat dish, thanks to my Jr diabetes police wrapped in a ” I love you DAD, I just want you to be as healthy as you can be.” Who can argue with that logic and those puppy dog eyes.

The artificial pancreas is considered the “Holy Grail” in Diabetes management and is one of the Focal points of this year’s Diabetes Technology Meeting, which is presented by the  the diabetes technology society and is being held  in Bethesda Maryland on Nov 11-13  2010

The meeting’s goal is to assemble technology developers and users to facilitate creation of new and cost-effective tools including  the artificial pancreas to help people with diabetes.

This year’s Diabetes Technology Meeting will include sessions on:

• Technologies for Metabolic Monitoring
• Biomarkers for Early Diagnosis of Diabetes
• Artificial Pancreas: Performance of Closed Loop Systems
• Alternative Delivery Routes for Insulin
• Diabetes Telemedicine
• Panel on Improving Adherence to Therapy
• As well as a live demonstration of some of the products  on the diabetes technology radar including the  Artificial Pancreas project.

Aggressive research in diabetes technology IS pushing  for more advanced solutions to diabetes, including novel insulin delivery methods, pancreas transplants, islet cell transplants, stem cell approaches, antibody treatment, vaccines, novel drugs, new continuous blood glucose monitoring systems and  a closed-loop blood glucose monitoring and insulin pump system, which is one diabetes technology product that may be approved for marketing in the very near future.

These diabetes technology products represent an enormous $36 billion global market annually, encompassing insulin, blood glucose meters, lancets, test strips, insulin pumps, syringes (and other delivery devices), continuous blood glucose meters and a broad range of anti-diabetic drugs (oral hypoglycemic agents) and other advancements in diabetes technology.

Like a jacques lemans watch, Innovation and functionality as well as a coolness factor are  being sewn into the fabric of some of the new diabetes technology products coming to market today and from this meeting, participants will be able to:

• Differentiate emerging technologies for measuring analytes affected by diabetes
• Define what is a biomarker for type 2 diabetes
• Identify barriers to development of an artificial pancreas
• List two new methods for insulin and metabolic peptide delivery besides needle and sponge injections
• Identify two necessary components of effective telemedicine solutions for diabetes care
• Describe technologies for improving adherence to diabetes therapy

While diabetes technology efforts are being dispersed in the search for a cure, it is the status of development of novel products including noninvasive monitoring, oral/inhaled/other insulin delivery that is the focal point until that happens.

I hope to see you all at the Diabetes Technology Conference

It was Friday the 13th after all and I must admit, even though I am bit superstitious, this was certainly not the time to tempt fate.

I thought I would  just tuck the envelop from the healthy kids healthy weight program.

I knew these certainly were the results from the glucose tolerance test. The results  that would tell us if  the son was pre diabetic or not.

Sunday after church, a prayer and (drum roll please) an “official” unveiling tells us the good news. The glucose tolerance test was normal, so the little guy is not pre diabetic after all, thank you God.

For a moment it seems like the weight of the world has been lifted off my shoulders, and I was so relieved I must say. Now all we have to worry about is controlling his weight, If we  can get that down then everything is right with the world.

One Instant of pure unadulterated Joy had me in a jovial mood all of yesterday, I was on a good high for once, everything from that moment on seemed to just go right for once. Good news of this magnitude has a way of lifting your spirit and melting all your troubles away, but that was yesterday.

I can  sense the smile on my face before I even awake, today. My morning routine goes down in a  flash, until I look at the meter and everything that was good about IT just disseminates in a cloud of smoke.

My fasting BG by the way is 317

I am feeling “Normal”,However, No high symptoms, no shivers, no thirst, not running to the bathroom every 5 minutes or any of the other diabetes signs and then it hits me like a bag of bricks.

This is the Normal Me, the every day me, the guy I see when I look into the mirror, that guy from yesterday, the guy who was on cloud nine was a complete stranger.

I am trying with all my might to replicate that guy, but like a fist full of sand, the harder I try to hold on, the more he slips through my fingers.

I truly want to escape this daily grind that is Diabetes If only for a moment but I know yesterday is gone and the psychological toll that this disease has borne on me is greater than any physical scars ever will  for such are the effects of diabetes.

Can you honestly remember as a diabetic, the last time  you had a feeling of pure uplifting Joy and how long were you able to hold onto that feeling before the effects of diabetes came bursting in?

Update: Aug 17 2010

Some facts on diabetes and depression thanks to D- blogger extraordinaire  David Mendosa

“Diabetes and depression go together. Research research found that 19 percent of people with type 2 diabetes probably suffer from major depression and an additional two-thirds of us have at least some depressive symptoms. People with diabetes are twice as likely to be depressed as other people.”