by Jane Merrill
I was hospitalized for two weeks when I was diagnosed a Type 1 diabetic at age 8, in 1960. During my stay, the nurses taught me about diabetes, urine sugar testing (with test tubes and eye droppers), diet and insulin shots. The rule was I could not be discharged until I could administer my shot by myself. How much insulin I took was based solely on the level of sugar in my urine. It was all a bit overwhelming to a child, and complications were not mentioned. However, because I was in a military hospital (my dad was in the Navy), I was with females of all ages, including a young adult with Type 1 diabetes. I was told she was “bad”: that she did not follow her diet and that if I followed her steps I would end up like her. She died while I was in the hospital.
As a child and teenager, I was rigorous about my diabetes regime. But as a young adult in a bad marriage, I did not take care of myself mentally or physically. I heard of complications and met people with diabetes and blindness and those with diabetes and kidney disease, but complications had not affected my life yet.
After 30 years of diabetes, I was driving home one night and saw red lights all around me. I realized something major was wrong, and I went to see an ophthalmologist the next day. He said I had diabetic retinopathy and that my retinas were bleeding. I was sent to a hospital about an hour and a half from my home, where I had several surgeries and many laser treatments. My sight in my left eye was spared at 20/900; but my right eye collapsed after multiple surgeries and was covered with a prosthetic shell. I took the loss of vision in stride, knowing that diabetic eye disease is the leading cause of blindness in middle-aged adults. And I was thankful I still had some vision, because all the diabetics with vision loss that I had met were totally blind. This was not a surprising complication!
Several years later, I saw my first podiatrist because I had ulcers on the toes of my right foot. The ulcers became infected, and the infections went to the bones. And one by one I had my toes amputated until my right foot had no toes. After healing, I walked a little differently, but there was no major impact to my life. Once again, by this point in life, I had met several diabetics with missing feet or legs, so I accepted my loss as part of diabetes.
A number of years later, I started having problems keeping my blood pressure at a reasonable level. It would drop to 30/55 and I would feel faint. My doctor told me to take decongestants to increase my blood pressure. About this time, I saw a new doctor. When I told him about my blood pressure and he confirmed it during my first visit, he told me to immediately start taking a medication because my kidneys were not secreting potassium and it was building in my blood stream. It could stop my heart. I had never heard of renal acidosis and never heard of it as a diabetic complication! I was aware of diabetics having renal failure, but this was different — a surprising complication! But one controlled by a medication regime.
Soon after, I experienced two complications of diabetes that were both surprising to me. I found that after eating dinner, I felt bloated and full. I took my bolus for my carbohydrates but after an hour, my blood sugar would drop suddenly, unbeknownst to me, and I would pass out. I learned I had two complications: my stomach was not digesting properly, and I had hypoglycemic unawareness!
Years went by and I settled into a medicine and insulin regime. I would have highs and lows, but my A1C and time in range were both excellent.
As I entered my seventies, I experienced more issues with digestion and found that — SURPRISE! — I had nerve dysfunction in my stomach and bowels, slowing the motility of my digestion. Once again, an addition to my medicine controlled the issue.
And just when I thought there were no more surprises, as I was approaching 75 this year, I had a series of orthopedic issues. First, with a pain in my knee I discovered I had a stress fracture in the condyle of my left femur. After waiting five months for a repeat MRI, I found the fracture did not heal, but had died. The doctor stated that it was a lack of blood flow to the bone that caused the death of the bone.
The repair required a partial knee replacement and bone cement in place of the necrosed condyle. The surgery went well and I was rehabbing until a new pain about four inches below my knee prevented my walking even with a walker. I went to the emergency room at 4 a.m. to find that my tibia was broken. The softness of the bone due to diabetes allowed the knee replacement to chisel away at the tibia, causing the fracture. I spent 6 weeks putting no weight on my left leg and have started 6 additional weeks of partial weight bearing before I can walk again. These were surprising complications of diabetes for me. I had no idea diabetes could affect bones.
Today, after 66 years of Type 1 diabetes, I have a number of complications that are controlled by medication or surgery. I have lived longer than most people who were diagnosed with diabetes in 1960 and expect to live more years. My personal experiences and those of people I have met or read about has shown me that diabetes is pervasive. It can affect any part of the body.
Newer technology and treatment protocols have prevented diabetics from getting as many complications, but there are still complications. So when you get symptoms and cannot quite place them, consult with your diabetes care team. You, too, could have a surprising complication!