April 17, 2014

Diabetes Does Not Have To Be Progressive

This blog by Nancy Klobassa Davidson, R.N. on April 4, 2014 represents a blog by a large medical organization (the Mayo Clinic) that identifies their blog author. No anonymity here like the blogs on Joslin Communications, a part of the Joslin Diabetes Center.

The topic is a controversial topic about diabetes being progressive. While I have to swallow hard to agree with parts of this, it is presented rationally and it is easy to understand. It is true that many people refuse to manage their diabetes in a manner strong enough to prevent diabetes from becoming progressive. The author does not account for the people that die of old age or other causes and not diabetes.

I would not argue that for many people, dying from diabetes or diabetes related causes (i.e., heart disease, kidney failure) is more common than we would like to have happen. We may be debating medical semantics, as some people have heart disease before developing diabetes and the same for kidney disease.

This statement by the blog author is important enough to quote. “Recently, I met a woman who was upset that no health care provider or diabetes educator had explained to her, at the time her diabetes was diagnosed, that diabetes is a progressive disease. She thought that if she "behaved herself," her diabetes could be cured, or at least stay in holding pattern.”

Yes, there are people with diabetes that mistakenly believe they can be cured. All I have to do is talk to the owner of a health food store and she will confirm this. She knows this is not true as she has type 2 diabetes, but says that about twice a month, someone will come to her store seeking a cure for diabetes. She tells me that people say the darnest things and her favorite is, “this is the twenty-first century, there has to be a cure.”

The author's logic presents both sides of the disagreement better than most. She does not state many of the obvious conclusions, but sidesteps many issues by saying, “this varies per individual, and everyone is different.” I can agree with this, because we all age and manage our diabetes differently. It is the definition of progressive that needs clarification. Progressive means aging or becoming older. With aging, our organs all lose their efficiency and the pancreas is no different.

For me, progression of diabetes would mean that it progresses to the complications and on to death. Some people are able to manage diabetes for many years (and even for decades) with nutrition (diet) and exercise. As the pancreas ages, oral medication may become necessary. As we continue to age, other injectables or insulin may become necessary.

As long as retinopathy, kidney disease, and heart disease caused by diabetes are not becoming worse with age, then diabetes has not become progressive. But you did not mention neuropathy you say. Correct, because about two-thirds of people with diabetes develop neuropathy and there is some conflict here as many, like myself, that develop neuropathy many years prior to being diagnosed with diabetes. My neurologist and I have an ongoing discussion about this as he says that with the development of diabetes, that the neuropathy is now classified as diabetic neuropathy.  Sort of the chicken and egg version of which came first.

Many people, without their doctor's threat, often feel that they have failed when it comes time to transition to insulin. Often they wait too long to do this. They haven't failed, it is just their normal thing as they age and the pancreas not functioning very well that causes the need for insulin. Insulin can be very helpful and a necessary tool in the management of type 2 diabetes.

Delaying to use of insulin too long causes high blood glucose levels and prolonged periods of high blood glucose is what causes the onset of complications. Insulin does not cause complications and in most cases if started early enough can prevent the complications and heal those that are just beginning.

Even though the blog used for reference above says diabetes is progressive, it is still worth reading.

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