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By Arne Vainio, M.D.
News From Indian Country Feb. 2010
 Frank never really needed to come in to the clinic. He used to lift weights and didn’t really think of himself as being unhealthy. He didn’t smoke, he didn’t drink and he didn’t do drugs.
At age 43 he didn’t take any medicines. But in the month before coming in he had a very dry mouth, severe cramping in his legs and a metallic taste whenever he drank anything. Over the previous 6 months he had gone from 250 pounds down to 200 pounds without trying. He was constantly thirsty, urinating frequently, feeling weak and constantly felt like vomiting. He came in to the clinic when his girlfriend noticed he was getting increasingly disoriented and confused.
In the clinic, he had a blood sugar checked. Our meters in the clinic
only go to 500, and his sugar was higher than that. The hemoglobin A1c
is a measure of blood sugars over the past 6 weeks to 3 months. Normal
is less than 6.5 and out of control is anything over 10.0. Our clinic
can measure as high as 14.0 and his was higher than we could measure.
His vision was blurry and getting worse.
He was sent to the hospital for admission as this was too complicated
to handle in the clinic. Once in the hospital he was given insulin and
started on a continuous insulin infusion to get his blood sugar down.
He had to be given liters of IV fluid as he was dehydrated due to his
constant need to urinate prior to coming in. This had to be done
carefully over 24-48 hours as replacing it too fast could cause
swelling of his brain. His blood pressure was low and his heart rate
was high as his heart worked hard to get oxygen to his tissues in his
dehydrated state. His potassium was low and had to be carefully
replaced as his blood sugar came down and his fluids were replaced. If
his potassium was allowed to go too high or too low, it could throw his
heart into a fatal rhythm.
Over the next 2 days we were slowly able to correct his blood sugar,
potassium and replace his fluids. We started him on insulin injections
4 times a day. His new diagnosis of diabetes hit him hard. He was
clearly overwhelmed and sad initially. “How could this happen to me?”
We went back over the few months before he came in to the clinic. He
used to lift weights, but life got busy and that fell by the wayside.
He gained weight with his decreased activity and ate more and more fast
food and snacks. “I really loved those double quarter pounders with
cheese and I was eating those little cupcakes that come 3 in a package
like they were a single snack. I was drinking pop steadily and was
getting addicted to it.” When he did cook at home, he was making soup
with white rice. “I thought that was a healthy thing to make, I didn’t
know white rice could be so high in sugar.”
His hunger for sweets and fatty foods was one of the first signs of his
early diabetes. His decreased activity and increased weight caused his
insulin to not work as well getting sugar into his cells (insulin
resistance). His blood sugars began to climb, but with his insulin not
working well, the sugar wasn’t able to get into cells. His cells sent a
signal to his liver to make more sugar and his sugars continued to
climb.
As his sugars continued to go up, his kidneys started to get rid of
sugar. Water followed the sugar and the result was his increased
urination. As he became increasingly dehydrated, he became thirsty to
replace the water, but his thirst was for sweet liquids and pop.
The lenses inside his eyes started to swell as sugar moved into them
and water followed the sugar. The muscles around the lenses could
contract for a short time to correct this, but would eventually tire
and cause his vision to get blurry.
His rapid weight loss was due to his body burning his own tissues for
fuel as he was unable to get sugar into his cells, even though his
blood sugar was high. The primary fuel for our brain is sugar, but as
he was using other fuels, he was unable to think properly and this is
where his confusion came from.
On discharge from the hospital, he was sent to see the Dietician and the Diabetes Educator at our clinic.
Frank was totally committed to learning about his diabetes and getting
it under control. He completely changed his diet and kept track of his
sugars. By the time of his visit 6 weeks after his hospitalization, his
sugars were looking great and his hemoglobin A1c was down to 8.5. His
cholesterol profile was still a little elevated, but was much better.
This usually goes up with elevated sugars and comes down when blood
sugars get better.
I saw him again today at 4 months after his initial diagnosis. His
sugars are completely normal and his hemoglobin A1c is 5.4. His control
is perfect and he wants to start lifting weights again. He will need to
watch his sugars carefully as he increases his activity as he will be
burning sugar for fuel and could actually get sugars that are too low.
But he understands what he needs to do and has totally dedicated
himself to keeping his diabetes under control and learning everything
he can about diabetes.
He knows this is a lifelong process and he has to constantly stay on
top of his diabetes. Frank’s turnaround is nothing short of amazing and
I told him there should be a billboard with his picture on the freeway
outside the reservation. How was he able to get this under control when
so many have such a hard time with it?
I asked Frank what he would tell people with diabetes. What would his
billboard say? This is what he says: “Anyone can do this. You can
conquer diabetes if you put your mind in the right spot.”
That doesn’t just apply to diabetes. It applies to any health condition
and our own personal habits. Frank has done what so many have been
unable to do. He’s taken charge of his own life and has taken
responsibility for his health care. He is in control of his future. I
am merely a guide and a cheerleader on his journey and that’s the right
spot for me.
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