It’s fairly obvious, but there is a lot of responsibility that comes with a diabetes diagnosis. I wouldn’t be sure of where to start with naming all the things – doctors appointments, prescriptions, insurance, diet, always being “on”. Specific to this entry though, taking care of all of your organs – not just your pancreas – is one of those things that has always been a priority for me. Diabetes is not an isolated disease; what I mean is that it isn’t specific to just one part of your body the way that some illnesses or injuries are. Diabetes affects every organ. The pancreas is responsible for the malfunction of insulin production, but to focus solely on the pancreas when treating or managing diabetes is a mistake. In healthcare, endocrinologists partner with podiatrists, nephrologists, cardiologists, ophthalmologists and optometrists, dentists, weight loss specialists, dietitians and psychologists.

I’m grateful that from an early age I understood that diabetes was a multi-organ disease. As a child I didn’t attend out of the ordinary classes that would have taught me the importance of this, nor was I especially gifted or interested in the human body when I was diagnosed at 14. And, it’s certain that when I was first diagnosed, I didn’t immediately understood that this disease would affect my entire body, but I understood enough to take it seriously. I’m so grateful for this.

In therapy several years ago, the diabetes behaviorist I was working with helped me to believe (which is different from helped me to learn) that if I took care of my blood sugars, I was, in turn, also taking care of all of the organs that might be affected by poorly managed diabetes. When I first started seeing this psychologist, the thing I was most fearful of was renal failure; I often catastrophized in my head about becoming dialysis dependent. I think this fear was informed by the work that I was doing at the time, as I frequently saw men and women in their 30’s on hemodialysis as a result of failing to tightly manage their type one diabetes. Although I could have easily taught anyone in my shoes with my level of diabetes control that the chances of dialysis “happening” to them was slim to none, I simply couldn’t believe it for myself. This psychologist showed me the literature; I read it, and it changed my head. He helped me to translate my knowledge into something that I could also apply to myself; I learned to be less scared of diabetes complications. This was primarily due to the fact that persons with well-controlled diabetes (this is a phrase that encompasses many things; for the sake of argument, the most commonly accepted definition of well controlled diabetes is an A1c of less than 7% or a time in range of greater than 70%) endured complications of diabetes far less often than those with poorly controlled diabetes. 

Fast forward to now. Although the aforementioned fear has remained mostly absent and less controlling of my mind, I’ve still been mindful to take good care of myself. Last week I went for my yearly diabetic eye exam. Despite what that suggests, this is a pretty run-of-the-mill exam. If I have understood correctly, most everyone gets the same exam and undergoes the same testing. Specifically, the name of the exam – a diabetic eye exam – simply implies that the practitioner is looking for signs of diabetes in the eyes. That looks like new blood vessel formation or hemorrhaging. I have had diabetes for 21 years, and I’m proud to say that I have consistently shown zero signs of diabetes in my eyes. It took me by immense surprise when the optometrist sat back into his chair and casually stated, “So, I see two small spots. One in each eye”. Ah… excuse me? I swore I didn’t hear him right, so he repeated himself and the words he spoke slowly started to take on meaning in my mind – I see two small spots… Just the year prior, you would not have known I had diabetes. Now… you would. I have to check myself here and ensure I’m not providing false information; the very minor amount of retinopathy that he was seeing is common also in persons without diabetes. Obviously there are many ailments of the eyes. Minor retinopathy can occur for a variety of other reasons, but because I have known diabetes, new blood vessel formation is automatically attributed to the diabetes. And that’s exactly what he saw – “minor” new blood vessel formation. In this case, I feel like the word minor is dangerously subjective… To be fair, the optometrist also stated that it is quite likely that, had he examined me the week prior or the week after, the “spots” might be absent. I had a difficult time understanding this at first, however I have concluded that that was his way of defining how minimal the damage was.

The result of the exam has created trepidation for sure. I have thought it through, I have felt threatened and I have felt angry. I have felt like I understood it from a scientific standpoint, but from the patient perspective, all I can think is, what the hell? 

I did a literature search, and it turns out this happens to a lot of people. The way that I have tried to understand it is this – diabetes is and has always been a progressive disease. I tell many of my type two patients that they will eventually end up on medication even if they are currently diet controlled. This is a scientific fact – type two diabetes is a progressive disease, regardless of level of control. I look at type one and retinopathy to have this same cause and effect relationship; and I’m hoping that’s accurate. 

For those interested, I have two pieces of advice. 

Control your blood sugar, and control your blood pressure. Time and time again – article after article, study after study – the results tell those of us with diabetes that we have got to focus on these two things. Depending on your diabetes and other co-existing conditions, we typically want your sugars no higher than 180 (that would be after a meal, encompassing the post-prandial spike) and no lower than 70. This is a broad range; it’s a tighter range for pregnant woman, a wider range for those with renal disease, etc. The same can be said about blood pressure, but usually we want it no higher than 130/90.

Optometrist versus ophthalmologist. I am not an expert in either field. I only know that an ophthalmologist is a doctor; they have been through medical school. An optometrist has not. I currently see an optometrist. Because the health of my eyes has been relatively well for many years, I am comfortable. Should my eye disease advance, I will not hesitate to consult an ophthalmologist.

That’s all for now, guys. 

Cheers.