Читать книгу Controlling Fluctuations of Diabetes Blood Glucose, Healing and Preventing Nerve Damage with Baby’s Milk - Leonida Lidman - Страница 7
ОглавлениеCHAPTER I The Urgent Phone Call about My Diabetes and the Medical Treatment that Followed
Prior to being diagnosed as diabetic in 1991, I suffered frequent urination; excessive thirst; blurry vision; fatigue; frequent indigestion; diarrhea; profuse sweating at night even in cold weather; swollen knuckles; pinpricks on my hands, legs and feet which felt like bugs crawling inside my skin. My former family physician, Dr. Antonio Loreno, called this “tingling sensation” and advised rubbing liniments and applying a hot water bag massage on my legs when the liniments didn’t work and elevating my legs when asleep. This only worked for a few hours but never completely relieved my discomfort.
For excessive urination and thirst, Dr. Loreno told me to avoid sweets, salty and fatty foods. For extreme fatigue, he prescribed daily over the counter vitamins; a refreshing warm bath before sleeping; avoiding alcohol (which I never drink) and caffeine from coffee which I drink excessively.
He ordered a blood test which showed the onset of diabetes. He referred me to a diabetes specialist, Dr. Muriel Levy-Kern, who classified the blood test result as “diabetes in limbo” since the blood sugar level was not high enough to be classified as diabetes and not low enough to assure that diabetes was not present.
Controlling Fluctuations of Diabetes Blood Glucose, Healing and Preventing Nerve Damage with Baby’s Milk
It was very comforting when Dr. Loreno advised that I could avoid diabetes by eating no sweets, no salty or fatty foods and exercise like walking around the block.
In the summer of 1991 an urgent phone call alerted me to a very dangerous medical condition.
Dr. Thomas Klepacki of the Prudential Insurance Company advised me that my husband’s life insurance application on my behalf was denied.
Sensing that I was nervous and defensive, he urged me to write his address: Prudential Insurance; Eastern Medical Operation at Fort Washington, PA. 19034 with his phone number 215-754-2401. It was a very unusual call. When he urged me to rush to the emergency room of our local hospital and tell my family physician to call him. I nervously replied, “I am not going to any emergency room and won’t call my family physician unless you, Dr. Klepacki, tell me why.”
After a few seconds hesitation, Dr. Klepacki said, “I am not allowed to give professional advice even though I am a medical doctor, since my work with Prudential is insurance. Your blood sample taken by the nurse from Prudential showed a dangerously high urine glucose level of 9 mg/dl and blood glucose of 652 mg/dl. I called you because this information alarmed me. I suspect diabetes.” He volunteered to wait an hour in his office so as not to miss my physician’s call.
What a very kind and caring man!
He continued pleading, “Mrs. Lidman, please go to the hospital. If you are unable to contact your family doctor, the emergency room physician will contact him for you. But please. PLEASE. Go to the hospital. Ask someone to drive you. You could lose consciousness. Your vision could blur.”
After I murmured, “Thank you,” he wished me well and hung up.
Immediately my husband rushed me to the emergency room of Bayshore Hospital in Holmdel, New Jersey.
The triad nurse recorded the information that Dr. Klepacki advised. Another took my blood sample and told me the results would be available in two hours. She led me to an improvised waiting room and gave me an oxygen tube as I lay in the bed.
I must have slept because when I awoke, the wall clock read 2 A.M.
How??? I got here after 5P.M.
I dimly recognized Dr. Loreno and Dr. Levy-Kern in their white doctor’s coats standing at my bedside.
“What time is it?” I asked.
Neither answered.
“Did I pass out?”
Controlling Fluctuations of Diabetes Blood Glucose, Healing and Preventing Nerve Damage with Baby’s Milk
Neither answered.
Gently, Dr. Loreno filled me in. He introduced the nursing staff who specialized in diabetic care. “You’re on the fourth floor of the diabetic department. Go back to sleep.”
Dr. Levy-Kern added, “I’ll go home to get some sleep too.”
Go back to sleep? How? I was wide awake.
How did I get to the fourth floor?
“Go back to sleep,” said the nurse who took my blood.
“Go back to sleep,” said another nurse who came for a urine sample.
“Hello, you look better,” said yet another nurse who took my blood pressure and pushed a thermometer inside my mouth, saying, “Under your tongue. Under your tongue,” looking at her wristwatch to check my pulse. “There. There. Very good. Very good.”
These nurses may be good at their jobs but how are patients supposed to go back to sleep when they wake us up as soon as we fall asleep?
They wake you up to take blood samples; they probe you with stethoscopes; they count your pulse; they shove thermometers under your tongue and demand urine specimens.
The worst place to sleep is a hospital.
Since Dr. Klepacki’s frightening phone call and my hospital stay in 1991, my life had not been normal until 2002 when I noticed a big difference in my energy level. This high level of energy continues to this date, 2009, after I made and followed my own diet plan (menu) based on the Glycemic Index Food information in the Glucose Revolution Books, suggested by Dr. Jennie Brand-Miller. I had more pep and a wonderful sense of well-being. My strength increased and I felt energized and ready to do all the endless household chores.
What made this huge difference?
“The food!”*
During my four day hospitalization, Dr. Loreno, Dr. Levy-Kern, a social worker and a dietician, along with the nursing staff kept track of my blood glucose. Too high or too low is dangerous.
To perform blood tests I was taught to prick the tip of my finger with a small lancet which holds a tiny needle; place a drop of blood on a reagent strip and insert it into a small digital machine which reports the glucose level. This taught me to be aware when my blood sugar rose above 160/180 mg/dl. The urine often contained white spots which are dried splashes of glucose-filled urine in the toilet bowl. I looked for this and noted it keenly in my daily logs.
This information helps my physician determine whether my diet went awry; whether there is a need to readjust my oral medication; whether other types of tests are needed; whether I should be tested for albumin.
Controlling Fluctuations of Diabetes Blood Glucose, Healing and Preventing Nerve Damage with Baby’s Milk
The social worker concentrated on my mental health – a major diabetic issue involving depression; suppressed anger; personality changes; mood swings; and the impact of all these on me every day.
She added the availability of health professionals, should the need arise.
I felt like a bewildered animal who lost its way. My diabetes felt like a death sentence.
A nurse educator visited me daily and gave me free diabetic testing supplies and equipment. She showed me how to take blood and urine samples and how to record the results in a special self-testing log. My reluctance irritated her since I cannot stand needles pricking me, let alone the sight of blood, especially my own.
According to the nurse diabetic educator, I must be keenly aware of my blood glucose level every day without fail. Here is what I learned.
| WHEN BLOOD GLUCOSE (mg/dl) is: | COMMENTS |
| Below 70 mg/dl | I must follow treatment plan for low blood sugar. |
| 70-120 mg/dl fasting blood glucose | This glucose level is ideal. No cause for alarm. |
| 70-140 mg/dl fasting blood glucose | This glucose level is acceptable. |
| 100-140 mg/dl blood glucose after meals (1 ½ to 2 hours) | This glucose level is ideal. |
| 120-180 mg/dl blood glucose after meals (1 ½ to 2 hours) | This glucose level is acceptable. |
| Above 200 mg/dl | Glucose level is not acceptable. I must call my physician and report this. |
| Above 240 mg/dl | I must test for ketones. If ketones are present, or if my blood sugar does not return to normal in 2 days, I must contact my physician. |
I learned so much from my hospital stay and from consultation with Dr. Levy-Kern, Dr. Loreno and hospital nurse-educator that I feel compelled to share my experience. The knowledge I gained about Type 2 diabetes from these skilled professionals guided me well. For instance, I was able to accept gradually that diabetes, a lifelong condition that has no known cure, is caused by increased glucose in the blood, by insufficient insulin production or by inability of the insulin to work effectively.
Controlling Fluctuations of Diabetes Blood Glucose, Healing and Preventing Nerve Damage with Baby’s Milk
In the beginning, none of this was easy to understand. When I was dangerously ill with this life-threatening condition, all I wanted to know is when I would get well and how soon.
It was mentally challenging to comprehend how food is broken down into glucose, the body’s main source of energy; that when insulin is absent, reduced or not effective, glucose cannot be transported to the cells for energy. When this happens, glucose builds up in the blood. This high blood glucose level causes diabetes.
The nurse educator and Dr. Levy-Kern both said that meal planning, physical exercise, medication, stress management and knowledge about diabetes all help blood glucose levels to return to or remain normal.
According to these professionals, diabetes is not contagious. Obesity and heredity precipitate it. Since I am never overweight, obesity did not play a role. The susceptibility to diabetes is passed from generation to generation through the genes but not in any predictable pattern. Dr. Levy-Kern said that heredity played a part in my being diabetic. I was diagnosed with Type 2 (non-insulin dependent diabetes mellitus) due to heredity since my father was diabetic and passed away due to its many complications.
Dr. Levy-Kern emphasized the necessity to watch for high blood sugar (HYPERGLYCEMIA) and low blood sugar (HYPOGLYCEMIC). I was given written information on what to expect and how to detect symptoms. Here’s the information:
KNOW THE DIFFERENCE BETWEEN HIGH BLOOD SUGAR AND LOW BLOOD SUGAR
| HIGH BLOOD SUGAR: (HYPERGLYCEMIA) | LOW BLOOD SUGAR (HYPOGLYCEMIA) |
| Symptoms noticed within hours to several days: | Symptoms noticed within minutes to hours: |
| - increased thirst and frequent urination | - cold sweats |
| - large amounts of blood sugar | - dizziness, headaches |
| - ketones in urine | - blurred vision |
| weakness, pains in stomach, aching all over | - inability to awaken |
| - heavy-labored breathing | - grouchiness |
| - loss of appetite, nausea, vomiting | - personality change |
| - fatigue |
Controlling Fluctuations of Diabetes Blood Glucose, Healing and Preventing Nerve Damage with Baby’s Milk
| WHAT TO DO: | WHAT TO DO: |
| - call doctor immediately | - take 2 glucose tablets or food containing sugar (orange juice, regular soda) |
| - take fluids without sugar if able to swallow | - check blood sugar level |
| - test blood sugar frequently | - do not give insulin |
| - test urine for ketones | - do not give anything by mouth if unconscious |
| - call doctor |
| CAUSES | CAUSES |
| - not enough insulin | - too much insulin |
| - too much food | - not enough food |
| - infection, fever, illness | - overly strenuous exercise |
| - emotional stress | - delayed meal |
For high blood sugar, Dr. Levy-Kern and Dr. Loreno strongly advised me to monitor the blood sugar and urine ketone levels. Urine testing for ketones can be done at home with test kits from the pharmacy. I prefer to have my ketone tests done in a laboratory to make sure there is no possible kidney problem. It is hard enough to have diabetes, and it is deadly when kidneys are affected.
Long ago my father said, “No one dies from diabetes, but diabetic complications will surely get you.” He should know. He died from diabetes complications of the kidneys, circulation problems and high blood pressure.
Prior to being released from the hospital, the nurse educator enrolled me in a month-long diabetes self-management course. Family members were encouraged to attend. The course included:
- general information supported by numerous pamphlets of information from various sources
- blood glucose monitoring
- oral hypoglycemic
- ketone testing
- hygiene, nutrition and meal planning
- stress management
- behavior medication
- group discussion
Meeting with other diabetics and their families helped the diabetic team to assist me to control my blood sugar and to understand personality changes and mood swings that impact my husband and children and inspire them to be more patient and tolerant.
Controlling Fluctuations of Diabetes Blood Glucose, Healing and Preventing Nerve Damage with Baby’s Milk
more patient and tolerant.
RECOMMENDATIONS FOR KETONE TESTING
Persons with Type 2 Non-Insulin Dependent Diabetes should call their doctor when:
1. blood sugar is greater than 240 mg/dl and ketones are positive in the urine
2. the blood sugar has increased over the past 12 hours and tests show the presence of ketones.
Two kidneys in the back of our spine above the waistline filter blood flow through tiny capillaries. High levels of ketones in urine warn of possible kidney problems. Kidney complications include fatigue, lower back pain and light burning sensation while urinating.
To determine whether my diabetes is affecting my kidneys, my physician recommends microalbumin laboratory tests at least once a year.
When I experience light burning sensations while voiding, I usually drink cranberry cocktail juice for 2-3 days. When the painful sensation does not go away, doctors prescribe antibiotics to treat possible infections in the urinary tract. Cranbury juice is now my regular beverage. I take a half glass at least once daily.
Oral medication was prescribed twice daily which, in recent years, was reduced to one tablet twice daily. I take my prescription to this day.
In the beginning, I was instructed to monitor my blood sugar every four hours, six times a day. Even at night I had to prick my fingers twice – I had to – even though I had difficulty getting back to sleep.
Pricking my fingers – forefinger; middle finger; ring finger – so many times produced ugly calluses. Sometimes no blood came out, since the skin had hardened. With the needle so small I feared it would break and embed the tip under my skin, so I often had to prick myself twice, sometimes thrice. I abhor pricking myself, even though the needle is small and the pain is bearable. Nonetheless, I cannot stand the sight of blood, especially my own.
Each month Dr. Levy-Kern smiled when she read my logbook showing a much lower blood sugar level than the previous month; or frowned when the glucose level rose.
In addition to daily pricking my fingertips, Dr. Levy-Kern ordered a hospital glycated hemoglobin blood test, or HbAIC, which gave a three to four month average blood sugar reading.
She explained that HbAIC tests measure how much sugar is attached to protein in the red blood cells, which have a life-span of three months – hence the three-month averaging of sugar level in the blood as determined in the laboratory.
I discovered that pricking a few times daily is truly meaningful. In the morning before breakfast my reading is mostly low; after lunch my blood sugar surges higher than expected. Before dinner the sugar level can be normal but after dinner, the glucose also surges within two hours.
Controlling Fluctuations of Diabetes Blood Glucose, Healing and Preventing Nerve Damage with Baby’s Milk
In the beginning it annoyed me no end to prick my fingers. I realized, however, doing so made me aware of the fluctuating glucose level which I had to avoid and control to prevent complications that could damage my body organs. The fluctuations of my glucose levels in different hours of the day made me realize that pricking my fingers just once daily was a grave risk. I began to appreciate the value, even though it depressed me immensely.
By this time I had a new family physician, Dr. Thomas Scuderi, who also treats diabetics. I explained my feelings to him. After examining me and reading my logbook which reflected stable glucose levels, he finally reduced the finger pricking to three times a day; then twice a day. However, even pricking myself once a day became exasperating for me. I simply couldn’t do it any more.
He finally agreed for me to prick my fingers three times a week – once every other day – on condition that on those days, my glucose level remain stable and that I strictly observe my Food Exchange Plan. I gratefully agreed.
As ordered, I strictly observed my food intake, dutifully took my prescribed medications and exercised moderately as required.
When I detected low blood sugar (hypoglycemia), I immediately pricked my finger. When the meter showed low blood sugar, confirming my suspicion, I took two glucose tablets which I keep with me everywhere I go during the day and on my side of the bed at night. Their melting in my mouth reduces my weakness and stops my profuse cold sweats and makes me feel warm again. Low glucose (hypoglycemic) makes me hungry and thirsty but the glucose tablets reduce my weakness and recharge my energy. As a result, I could easily go to the kitchen for toast, unsalted crackers and a half glass of orange juice.
During hypoglycemia attacks which happen often in my sleep, I can hardly get out of bed to walk to the kitchen for those unsalted crackers and orange juice.
How do I detect hypoglycemia when I am deeply asleep? Cold perspiration soaks my pajamas and wakes me up.
When I continue feeling cold all over even after taking glucose tablets and wearing extra clothing, I call Dr. Scuderi who usually asks me to report to his clinic for observation.
When I detect high blood glucose (hyperglycemia) by heavy-labored breathing when I am not doing anything; nausea; body aches, I immediately prick my fingertips to see if my blood sugar rose very high. When it does, I immediately take water preferably, followed by a couple of hours of rest and sleep. When I wake up feeling my blood sugar is still high, I prick my fingertips to see how high. I always make a doctor’s appointment when the blood sugar remains high. On a few occasions while under observation at Dr. Scuderi’s clinic when my blood sugar remains high (over 250 mg/dl), I was given insulin injection which lowered my blood glucose in one to two hours, after which I felt fine again.
Controlling Fluctuations of Diabetes Blood Glucose, Healing and Preventing Nerve Damage with Baby’s Milk
Hyperglycemia (high blood sugar) happens over hours and days. It gives you time to observe symptoms and call for help.
Hypoglycemia (low blood sugar) happens fast, leaving minutes to an hour to attend to it. Unattended low blood glucose causes coma or death but it is preventable. Low blood sugar is more dangerous than high blood sugar. The danger of low blood sugar is the main reason I refuse to take the mildest sleeping pills during nights when sleep eludes me. What if my blood sugar went dangerously low? I might not wake up at all.
Hyperglycemia happens over hours and days, giving me 24 hours to observe my symptoms and to call my physician or rush to the emergency room when my blood sugar does not go down to an acceptable level after all the precautions detailed in this book have been observed.
Both high and low blood sugar are dangerous when neglected. My response to both is eternal vigilance. My body warns me. Testing my glucose level confirms those warnings mentioned in this book and I heed them.
During a monthly consultation in the earlier years, my diabetic specialist assumed, correctly, that I had been diabetic before I was medically diagnosed. Therefore, very high blood sugar for years, which led to the phone call from Dr. Klepacki, possibly caused nerve damage or diabetic neuropathies which caused the painful tingling in my hands, legs, thighs and all-over aches and pains.
My family physician and diabetic specialist, in consultation with each other, referred me for a general physical examination, consisting of more X-rays; magnetic resonance imaging (MRI); ultrasound of my arms, shoulders, legs, eyes, ears, nose, throat and thyroid glands; urinalysis and cholesterol to discover the causes of my aches and pains and possible undiagnosed illnesses.
Those exams revealed no organ damage. However, my diabetic specialist concluded that my aches and pains were due to nerve damage in the periphery of my legs, brought on by my diabetes. Neuropathies are difficult to treat, much less prevent when patients don’t fully cooperate. “There she goes again,” I thought ruefully, biting my lips to prevent myself from arguing.
I knew what she meant. She meant that my aches and pains or nerve damage were because I stopped pricking my fingertips 4 to 6 times daily. She argued against reducing those prickings as allowed by Dr. Scuderi to once a day even when my logbook consistently showed a stable glucose.
I believe that these aches and pains had been with me for a long time before I was diagnosed as diabetic.
How can these neuropathies be prevented now by pricking my fingertips?
Why won’t she just remedy my problems?
I just suffered in silence morosely.
