February 12, 2011

Lessons Diabetes Teaches Us – Part 1

We all learn from diabetes. Necessity is the teacher and not a patient teacher at that. If we don't follow instructions, we pay dearly for those lessons. If we think we can outsmart diabetes, are we in for a rude awakening. Diabetes does extract a toll whether we are willing to accept the charge or not.

Many of us have experienced college, but the college of hard knocks teaches us the lessons we need for life and living. The grades handed out are how we live and manage our daily living. Diabetes is its own college and can knock us around unmercifully unless we learn how to manage it. Otherwise it loves to manage us.

David Spero at diabetes self management approaches this a different way and has it as a class. To me it is a degree by itself and has many courses to cover the complications and idiosyncrasies of the disease. Some classes are easy to pass and others take some study and much patience to pass the course. Some classes are for the short term and others are lifelong.

One of the hardest lessons that many just never seem to learn is diabetes is not your fault. Whether you have Type 1 or Type 2 diabetes, LADA, or one of the MODY types, they may be caused by genetics, environment, or even some unknown genetic abnormality. This even applies if you have medically induced diabetes, see my blog here.

The second lesson is you must learn that the past is past and you must learn to live in the present and manage your diabetes. This is hard for many people also as they want to continue to heap blame on themselves and then go into denial. Diabetes loves this phase as it gets to do what it wants with your body and you are being managed by diabetes and not the other way around.

Acceptance if the final lesson and is when you have removed your fist from the panic panel and are mastering the lessons of diabetes and how to best manage this chronic disease. These lessons do not not manifest themselves in the same order for everyone and anger is another lesson that some people have a difficult time getting past. For me anger was short lived and denial can later even after I had accepted diabetes. So be careful in how you analyze your situation.

Gretchen Becker in her book The First Year, Type 2 Diabetes, discusses three of the common complications of diabetes as the three O'pathy sisters. I like her humor to get you to remember how serious these complications are. Neuropathy is damage to the nerves and for some can be very disabling. Nephropathy is damage to the kidneys, and retinopathy is damage to the retina of the eye.

Then she adds Arthur O. Sclerosis for atherosclerosis which can lead to heart attacks, strokes and open wounds on the feet and legs. Yes, indeed these can be very serious and debilitating for those that don't manage diabetes. These require you to manage diabetes by maintaining control as near to normal levels of blood glucose as possible. This management may delay or even prevent their development. These are considered the big four and most common complications.

Please read David Spero's blog here. He makes some excellent points that I chose not to cover and they are to the point. My next blog will be about some of the other complications and related problems.

February 9, 2011

Obstructive Sleep Apnea Surgery

I don't know what it is lately, but apparently surgeons are trying to build their retirement fund before the Affordable Care Act gets before the Supreme Court. I am reading more and more about surgery being the solution for more and more health problems. That in itself sets off alarms about what is happening in healthcare that has surgeons operating everywhere they can.

Some surgeries are for the best and are unavoidable, but for obstructive sleep apnea, I have a real problem with this as even the American Sleep Apnea Association (ASAA) is very cautious about recommending surgery. Most surgeries cannot be reversed and can leave worse problems than using other options.

Apparently the surgeons at Henry Ford Hospital in Detroit have determined that it is acceptable and are trying to convince other surgeons that surgery is best. Since I don't have access to the full study, I can only assume that they did not compare results of the Epworth Sleepiness Score (ESS) questionnaire for those that have success with CPAP Equipment. I know that after being on the CPAP machine for three months that my score would have been 0.5 compared to the maximum score before the sleep study and use of the CPAP machine.

I can understand why the study only selected obstructive sleep apnea patients that were not successful with the CPAP equipment as this group would show an advantage for the surgery. They also don't state the sex of the participants to determine whether there were problems other than just the equipment that may have caused these patients to have problems with CPAP.

Before you let this study influence you, I would suggest reading what the ASAA has to say about surgery and then read my blog about surgery here. Please read what patients on site 5 have to say about surgery.  I know that I would not want surgery that is often less than successful and cannot be reversed. I have and use a CPAP (actually VPAP) and use nasal mask liners to keep air from escaping around the mask. Yes, I do get marks from the straps holding the mask, but within a short time after taking the mask off, they are unnoticeable.

I would encourage anyone to give the CPAP equipment a chance to work or if needed an oral appliance, before you even consider surgery.