Diabetes and other complications

When I was 38 and working every daylight hour and more to pay a mortgage on my first house, as well as feed and educate a young family, I got ill, something I could (pardon the pun) ill afford to do.

My weight was fluctuating, almost weekly. I was always thirsty, all the time and had taken to carrying a bottle of water around with me, long before it became a fashion accessory.

diabetes

So I was visiting our family doctor, not for myself, but for my four year old daughter who needed a check up and a prescription for her asthma. While I was there, I mentioned my fluctuating weight and thirstiness to the doctor and he handed me a plastic cup and a litmus strip and asked for a urine sample. “You could pee on the strip, too,” he told me.

I did as he asked and he looked at the strip and frowned. I found out later the strip tested my urine for ketogenesis, a condition that, along with the other symptoms, might indicate some liver disorder and raise alarm bells and suspicions. He asked me to wait, a moment, in the reception area, while he made a quick call. Two minutes later he asked me to go home, pack a small bag and then go to the local hospital where I would undergo some tests.

If my urine had set off alarms, his urgency raised me to DefCon One. So I asked him to explain himself and he told me, ‘I think you have diabetes and I want to make sure.” So would I be in hospital, overnight? I asked. “No,”he said, “this will take a week.”

And why the urgency, I asked, is this life threatening or something? I asked, surprised by his haste and a little bit put out by the inconvenience it might cause me. “Yes, it is,” he told me, “particularly because of your age. It is very rare of someone of your age to manifest diabetes like this. You’re not overweight, even if your weight has been fluctuating and you’re fit enough.”

Later that week, when the first test results indicated I had type 1 or insulin dependent diabetes. There is a 7 in 100,000 chance of late onslaught type 1 diabetes in adults between the ages of 30 and 50.

This was discovered after a battery of tests that included blood and more urine tests and a liver biopsy. The rest of ther week was spent in nutrition training and gym sessions where I was put through a diabetes boot camp and the message was drilled home: no sugars or fats, lots of fibre and complex carbohydrates and planty of regular exercise. They gave me an orange and a hypodermic syringe full of water so I could practice injecting. Then they taught me to inject myself.

By the end of that week in hospital, my sugar levels were back to normal and so began a life of daily self medication. And this is where it gets really weird. It took another six years for the diagnosis of my haemochromatosis and the discovery that this had caused my diabetes.

Now, it appears, my diabetes can not be classed as type 1 or type 2, but a class of diabetes that can only be associated with haemochromatosis, somewhere between the two but because of my original diagnosis, I’ve had to maintain my administration of insulin.

So why, you might ask, was it not diagnosed the first time, the haemochromatosis not noticed and diagnosed, saving me a measure of future grief? Well, haemochromatosis symptoms often don’t manifest themselves until people are in their middle years or, at least, over 40.

But you got diabetes when you were 38 and that set off alarm bells? Yes, that’s true but many tests were done, particularly a liver biopsy, that showed no abnormalities in my liver function. What wasn’t done, though, because of the liver biopsy results, was a ferritin test. These days, this has changed and anyone manifesting diabetes, over 30 years of age, will automatically be given a ferritin test.

At the time, I thought, hey’ of all the long term conditions I could develop, diabetes isn’t the worst. Apart from the incovenience of constantly testing the sugar level in your blood and injecting yourself with insulin, a properly controlled diabetic lifestyle can be quite healthy, if you eat good and exercise, regularly.

Although, sometimes, even those can be inconvenient but, well, that’s a story for another blog.

Advertisements

Blood Letting

Imagine my surprise, having, first, been told I have a genetic blood disorder, to learn the only way it can be treated is by bloodletting, a medical practice that’s been in use for more than 3,000 years, all the way back to Ancient Egypt.

These days, they call it phlebotomy and it’s not performed by barbers or dark alley quacks, but by specialist medical practitioners under hygienic conditions, in modern hospitals. Well, for the most part, anyway.

In modern medicine, it is used in the treatment of polycythemia (excess of red blood cells), as well as haemochromatosis (iron overload).

Bloodletting is one of the oldest medicinal practices and was practiced by Egyptians, Mayans, Incas and ancient Greeks. It was used to treat a variety of conditions, based on the belief the human body was made up of ‘humours’; blood, phlegm black and yellow bile.

blood1

Depending upon the condition, measured often by the manifestation of these humours, a physician would decide where the incisions were made to drain blood and, ultimately, to draw the humours of the body into balance. In the Middle Ages, the task fell to the local barber, hence a barber’s pole, the swirling red and white, which represented the tourniquet, the blood and the rod gripped by the patient, during the treatment.

pole1

US President George Washington was among bloodletting’s many victims. He had 3.75 litres of blood taken from him over a ten hour period. He had a throat infection. In the 19th century, although bloodletting remained popular, particular with the use of leeches, its effectiveness was increasingly in question, particularly as more people were dying from its use than were recovering.

blood2

For people with an iron overload, however, bloodletting, venesection or phlebotomy is a good thing. As red blood corpuscles carry and distribute iron around the body, then removing blood can reduce the level of iron, too. The trick is to remove it faster than the body can replace it – an inexact science dependent on a whole bunch of factors – and that dilution will result in a reduction of the ferritin level in the body.

So two or three times a year, I have my blood tested for a ferritin count and if it goes beyond 150 then I must return for treatment, a weekly visit to a phlebotomy clinic where about 400ml/l of blood is taken from my blood, then I’m given a cup of tea or coffee and sent home.

Fun with Metal Detectors

Sinead O’Connor saved my life. Yes, that Sinead O’Connor. We were close friends and lovers at the time. She was dropping her daughter off at school and stopped at a shop to pick up a copy of the Irish Times, on her way home.

There was an article on the front page about a medical conference happening in Dublin and how the keynote speaker, Professor John Crowe, had read a paper about a blood disorder that came close to wiping out the Celtic race, a millennium before.

IMG_0694

She read on and began to realise the symptoms of this disorder were manifested by her boyfriend: arthritic pains in my fingers, particularly the left index; bouts of fatigue and diabetes. So she called me and I called my doctor. I explained to her what Sinead told me. My doctor asked me to come in.

There’s too much iron in my blood. It’s called hereditary haemochromatosis and it’s caused by a faulty gene. The body absorbs too much iron from the diet and then it deposits in the liver and other organs, particularly the pancreas. It also deposits itself in the joints.

Globally, one person in twelve has a chance of having that faulty gene but if you’re Irish, you have one chance in six. That’s why it’s called the Celtic Curse. It has other names, like Bronze Diabetes or Blood Rust.

Twenty five years ago, I was diagnosed with Type 1 diabetes. Ten years later, I began to experience pain in my joints, particularly the index finger of my left hand. As a journalist, who had to meet numerous daily deadlines, that was painful. Think, while you’re typing, how many times your index finger hits the keyboard.

Back then, I was experiencing frequent bouts of fatigue which, considering my work schedule, didn’t surprise but it did frustrate me.

My doctor performed, what I now know as, a ferritin blood test and, since she worked, as a sideline, in the blood testing laboratory of a local hospital, asked me to come back the following day for the result.

As suspected, my blood showed an inordinately high level of iron. It read 1450 units, she told me and what, I asked, is the normal level of iron? Anywhere between 15 and 50, she answered. An appointment was made with an endocrinologist and two days later, I began my first treatment for haemochromotosis.

Since then I’ve got two artificial hips and no, they don’t cause panic in airport metal detectors because they’re made of a chromium alloy, which doesn’t set off alarms. That said, whenever I travel, I carry a letter from the surgeon who performed the arthroplasty (hip replacement), because it is better to be sure, than sorry.

But that’s for another blog…