Big D's

Scientists actually know precious little about how the brain works. Intricacies of memory and thought often baffle the researchers. I understand the basics enough. As a science fiction writer I know generalities and specific details about many things, enough to give advance thought and theory but not an expert unless I specifically research a topic and I can often forget the specifics. My mind is limited and usually stretched too thin across too many things.
I understand the chemical imbalances of depression and when the depression is emotional. For months now, as the eyesight has been steadily deteriorating, the depression has gotten worse, with definite biochemical interaction to the despair of my situation.
My mind works by association, I pay attention to assorted random things and have made definite connection between lifelong cycles and my changing situation.
Constant lower sugar levels bring on a biochemical depression. This is now constant low sugar; the A1C numbers will still be higher than any level that any doctor will find acceptable.
I heard a news bit more than a decade ago and putting it into practice seems to have lent weight to the theory that fish and seafood acts as a natural antidepressant. It doesn’t cure me, but I do just feel better the day after eating scallops or whitefish or a tuna sandwich.
All of these fish sources male ,e dream. I am one of those who normally does not remember dreaming, but have never denied that I do. I have vivid dreams the nights of fishy meals. It took a year or so of my time traveling to England on business to realize that I was dreaming due to regular fish intake, not because of a tendency to eat hot custard deserts while there. My roommate always has vivid dreams when he has done a routine trip to Maine. He thought something about being in Maine made him dream, even when he returned that same night. I realized that his typical Maine lunch of seafood (usually tuna) was the true cause. He has no depression or dream issues otherwise.
I have come to believe that people who do not remember dreaming are more prone to depression. More recently, I’ve come to theorize that Vitamin D plays a major role in the chemical equation. The core of the belief if seasonal depression. Less sunlight, less Vitamin D, more depression.
In the last year and a half, as my mobility has decreased, my Vitamin D level has fallen from normal healthy levels above 25 to "insufficient" at 20 and finally to "deficient" at 13. I can’t see where I’m walking and can’t walk where I’m seeing. I don’t leave the house as often. It’s too much effort for too little result. There can be stretches of days where I just don’t leave the house and get no direct sunlight.
Vitamin D can’t be effectively gotten through diet. Sunlight or supplement is essential. Milk actually does not have enough. Online research indicated that the only equal is two servings of fatty fish per day. Besides lacing variety, such a diet can raise big stinks. Lack of vitamin D can produce bone problems, but also result in a variety of other debilitations, including muscle atrophy. I’m sure it has also contributed to the severity of the depression.
I’m taking the supplements as well as an antidepressant.
I’m still trying to pull myself back up.

Physical Low

When I don’t get frustrated or simply wake up with the buzz of low sugar level and insulin shock, certain physical conditions are evident. Keep in mind that this is not a comprehensive list of all symptoms that can occur, but the physical symptoms that usually hit me.
If I have eaten within a few hours of the sugar level dropping, one of the first physical symptoms is flatulence. I control this when I can, but that’s not always comfortably possible. What I ate makes no difference. This does not happen when my stomach is bare empty. This effect happens most often when the sugar drops due to increased physical activity rather than just not having eaten enough.
I will get tingly, especially in hands and feet, an itchy hot feeling.
I get hot and usually sweat. This is often the first symptom to subside with food as blood goes to the belly. I normally get cold after eating if it is under about 60 degrees F or less, and things have been that way since the 1990s.
I get weak and light headed. These days, this aspect will include vertigo. As some of the medications I am on and the eye problems themselves can cause vertigo, I am not sure to what extent the change in Wal-Mart’s ReliOn Insulin causes this specific problem.
Generalized shakiness will overcome me. More often than not, motor control diminishes.
There is a panic sense of urgency. When the sugar starts to fall I can put off resolution, but once a critical level is reached nothing can distract from the need. At advanced stages of low sugar, this does not become a short temper issue, but an exclusive focus on eating to ignorance of all other factors. I totally disconnect from anything else until the blood sugar levels rise.
Overall, it is a very weak and vulnerable feeling.
I have never had fainting spells or passed out due to the sugar being low. This may very well be because the sugar drop is typically a relative fall to where my sugar had been rather than a sheer drop to a home meter test number of 70 or less. While working on trying to get the numbers down last summer, I often let the low sugar feelings stretch out. That did not seem to work. Even as I felt everything was lower, the A1C remained high. There’s been considerable drug interaction in the past ten months, and my disabilities have had other effects that I should have anticipated....

Feeling it Out: Mid Life

My experience of watching other men deal with their mid life crises had provided me experience than just with my father, who is the type who would probably deny ever having had a mid life crisis. Fathers, bosses, mentors...most ruined things for themselves in one way or another. I sought to avoid that.
I had that "what to do and how to get there" life crisis early, at high school rather than college age. It’s no surprise my mid life crisis came at 36 rather than in my 40’s. It was mild. I developed an uncharacteristic infatuation that I could not make develop. I regretted having little financial savings. I listened to other people who told me I should be taking care of myself better health-wise.
At 43, I am still shunned by the former object of my affections. My main means of savings is still home ownership and equity–always iffy in this economy. And now I am not only disabled but feel like crap.
My diet had never been bad. The sole dietary change I made was switching from real sugar to Equal in my morning coffee. I had developed the sugar habit to boost my sugar in the days when I could not actually afford to eat anything for breakfast. That had changed. The other significant change when I started "taking care of myself better" was following my GP’s guidelines of taking a much higher insulin dose at night. It made sense to me as I knew by feel that overnights were the main time I sugar would rise to uncomfortable levels.
My sugars did lower, although never to the A1C numbers my doctor wanted to see. I was no longer getting up in the night to go pee. Instead, I was not able to sleep because the sugar levels felt too low. Too high, and I don’t get good sleep because I’m off to the bathroom a few times each night. Too low, I just can’t actually fall asleep.
I still seldom find that right balance.
This past spring and summer, I made a renewed effort to get my sugars lower, no matter how I felt. The inflamed Charcot foot had further impeded my circulation enough to cause the quick and massive infection that almost cost me a toe. The night of that hospital admittance also emphasized one particular problem food that raises sugars beyond expectations. (Low fat milk, which I will address in detail before long.) I succeeded, and am feeling so much worse for it.
Here’s how the diabetic things feel these days.
My blood pressure went back to normal levels when the Charcot inflammation subsided. The reduced swelling is probably more of a by product of the prednisone I still must drop into my eye than true healing. The foot is stable, but the Crow boot is a permanent fixture due to the ankle collapse suffered from the reduced circulation. I have frequent vertigo issues, which is probably a combination of the eye maladies and reaction to blood pressure medication meant for a worse situation than I am now in. Any of the four to five eye drop medications may also play into the vertigo.
My eye is a mess and my vision is getting worse. The strobing light exams contribute to this. The eye drops reduce vision at least temporarily when taken. Debris may be built up in the silicone oil that still remains in my eye. Light sensitivity is still blinding, darkness vision is non-existent, and the "retinapathy veil" grows darker. On doctor’s instructions, I had stopped the eye pressure drops when the pressure was good, and it re-rose to scary levels, so those drops are to be continued indefinitely. The prednisone still gives stomach problems, but not as severe as they were last winter.
Long story short, I’m the mess I had sought to avoid ever becoming after re-examining life in middle age. Maybe that "male menopause" just can’t be avoided.

Feeling it Out: High Life

My GP doesn’t fully understand the quirks and nuances of my sugar levels, and that seems to permanently maintain our lack of consensus on treatment. I do try to go along with his recommendations, but for me, it is more important to feel good than to be good according to numbers.
I feel good and function when my A1C runs towards 14, double the guidelines. Standard home testing numbers have run at 400 and I have felt a relative low in the blood sugar.
This isn’t normal, and I know it.
I do not let the sugars linger at levels that feel high. If I start peeing too much or get the heavy "clunky" feeling of high sugar, I take more insulin, without hesitation.
I’m not recommending this high life, but am just accounting for the slow rise in my numbers over a period of years, with note that my body adapted well to it.
Periods of sincere attempts to manage more according to my doctor’s wishes ushered in periods of not feeling well. The lowered numbers always seemed to usher in other problems, including the problems that now have me permanently disabled. I do not believe it just "caught up with me." I think the changes made me a "fragile" diabetic. The timing of bodily changes to the development of problems that led to other problems was too exact. For all the "typical" connections between the things that have afflicted me and being diabetic, none of my problems spontaneously "combusted." All of them had catalysts that can be traced outside the diabetes.
I’d love to feel healthy again, but I am too much of a realist to entertain pipe dreams. The damages are now done and there is no going back.
I talk with other diabetics I know, whether Type 1 or 2. I have yet to meet anyone who maintains proper numbers–A1C >7 and home testing at 120–who actually feels good. Most seem to get more discouraged by berating from doctors and caregivers when they can’t get their numbers to those levels. Those that do don’t feel good when or if they get there.
Average people in diabetics’ lives just don’t seem to get the delicacy of the balance.

Blood Sugar Downer

The change in Wal-Mart generic insulin manufacture has brought more frequent periods of discomfort with "low" sugar levels. I use quotes on "low" as acknowledgment that this is by feel, not by blood testing numbers.
Overall the sugar has felt lower with the Novolin than it had been with the Humulin formula. Since the toe problem that landed me in the hospital in the spring, I was making a concentrated effort for an overall lowering of the blood sugar. The change in insulin seems to have made a sharper change in that direction, unfortunately at a time when I was looking to slowly raise it again so I would feel overall better health.
People, including my GP, do not understand that last statement. Diabetics do. I do not feel as good when the sugars are lower. Diabetics who are good doobies and paint by numbers also report that they feel less well when their sugars are at better numbers. I’m still waiting for that lucky day when I meet a doctor who understands that how a patient feels is somewhat more important than what test numbers statistically say about their health. At least two of the three other diabetics with whom I have most recently spoken with in general terms report that they primary care givers and/or diabetic specialists have railed against missed target numbers without regard to how the patients were actually feeling, so I am not holding my breath on meeting the more compassionate and logical doctor. Both of those acquaintances were discouraged that no effort seems enough.
I have never recovered the feelings of wellness and functionality I possessed prior to "taking care of myself better." By the full chains of events, I would not be blind nor crippled by the collapsed ankle via Charcot foot if I had not started taking care of myself better. I My numbers had risen again and things got better, but never back to where they had been, even discounting the blind thing and the cripple thing.
I did make a renewed effort on my own after this spring’s hospitalization. The Charcot foot had nearly totally impeded circulation in the foot, allowing for the sudden infection and almost instantaneous gangrene and the collapse of the bone structure that has permanently impaired my ankle. My largest steps were to eliminate as much of the big (and hidden) source of sugar in my diet as possible, and letting my sugar levels stay at critically low feeling longer than I usually would.
I don’t need an A1C test to know I have succeeded. I don’t feel as well as I did prior to the hospitalization. Fatigue is constant. When the sugar hits a low feel level, the physical symptoms hit much sooner after the temperament issues than they used to. Those temperament issues are more severe and the "calm" times between are periods of severe depression that is biochemically impacted beyond the constant "useless gimp" feelings that are situational depression that anyone would feel in my situation. My thoughts are usually slower. I tire more easily. Stamina is gone. Neuropathy burns are more frequent. The depression had reached such an abyss that I found no choice other than to resume antidepressants.
Does this sound like healthier living?
It sure don’t feel like it.

Untested Theory

I do not test my blood sugars for reasons that make logical sense to me, including the hastening of neuropathy problems in the fingers and moral outrage that pharmaceutical companies’ financial interests take priority in this country over the long term interests of patients. Other alternatives exist but are suppressed for the profitability of test strips and lancets. I am not alone in this; one of the doctors I saw about a specialized problem in the past year is a Type 2 diabetic who also does not home test. Like me, he relies on A1C tests to gauge his progress or lack thereof.
Readers, however, should keep in mind some things about this (non) practice. The first is that I fell into it out of necessity during financially destitute times, not an intentional rebellion from the inescapable status of being diabetic. I had been diabetic for fifteen or more years by that time and paid attention to what my body would tell me.
Non-testing could be dangerous to those who can’t or won’t pay attention to their bodies’ telltale signals and I do not advocate the practice even while discussing it. Knowing the signs can take time, so newer diabetics need to go through the regimen up until a time that other home testing alternatives are made available.
I stopped even urine testing due to financial constraints sometime around 1989 to 1990 and managed the sugar by feel. One key aspect of this, something I had to "unlearn" from prior diabetic education and parental control. In that abandoned approach, the theory impressed on me was that the insulin was taken only at certain times and the rest of your life was to be planned around that until the nest scheduled dose. I think most people can imagine the post high school difficulties in this, with college schedules and variable work schedules. Employers certainly understood it: I had been told outright in 1987 that I would not have been hired if the boss had known I was diabetic. Wonder how many bosses since just never said so outright after such statements became illegal.
The new approach I adopted was to react to what my body told me. This is not just a matter of eating when my body said it needed food, but shooting up with more insulin if my body said it needed that. This had not been an approved method of treatment growing up. Starving the patient was the directive on food, and taking insulin outside the approved times was also not allowed. This mentality left me with long stretches of feeling uncomfortable and probably triggered some aspects of old bodily damage.
My refusal to test my sugars outside occasional A1C lab tests (the same method that doctor I mentioned uses) does not equal not taking care of myself or emotional denial of my condition. I feel uncomfortable whenever the body feels that the sugar is too high or too low, and will make efforts to moderate extreme feelings.
But as I managed by feel for more than two decades, my body diverged entirely from the medically approved number scales of any blood testing. I feel good at what are considered to be horrifically dangerous numbers. Any and all efforts to control the sugar by the numbers has resulted in the manifestation of side effects and complications. I felt healthier when I was a purely "bad diabetic" by professional standards. In the decades of no testing, even by A1C, my body regulated itself to a place it wanted to be and I could fully function in every way, but the numbers rose to levels that make my GP wonder why I had never been in a coma. I had managed by feel and in light of the problems that have developed as a result of "taking care of myself better," I wish I had stayed with the "lifestyle" that had worked so well for me for so long.

Burns and Blood

It’s easy to confuse the specifics among generalities and similarities. I have caught myself doing this recently in causes and effects within my legs. I don’t think aspects of this mistake hit the blog, but it’s better to be clear.
A diabetic is inclined to have many problems with their extremities. My earliest side effects of being diabetic related to my legs below the knee. My lower legs easily cut or scrape with the slightest aggravating touch. These minor mishaps generally heal well but do scar easily. The other longstanding sign is caused by my good habit of protecting my feet with constant covering of quality socks. I should all along have been using socks that did not constrict around my ankles as much. I should have been choosing socks with less upper elasticity. The tighter socks had a tendency to rub constantly on my legs. My legs could rival the hairiness of a spider’s legs, except that socks tend to shear away hairs along the lower shins and ankles. The natural indent behind the knobby bone of the ankle maintains a tuft of hair because the socks stretch over the area rather than rub against it.
These quirks result from diabetics’ reduced circulation. Neuropathy is a completely different affects the same areas as reduced circulation, but is a completely different thing. Neuropathy is a condition of the nervous system. Circulation is blood flow. Reduced circulation hinders the main function of the blood stream: delivering oxygen throughout the body.
Neuropathy causes different problems. Usually the first sign is reduced sensations of touch and feeling. The diabetic may not feel minor cuts or other injuries to the feet and lower legs and the hands. This can be dangerous as unknown injuries will remain untreated. The poor circulation conspires with the neuropathy to raise these risks of infection and gangrene, as I perilously learned last May, as recounted in most of the entries under the "Sturdy Hospital" label.
The second most common sign of neuropathy is burning sensations. This generally occurs as the problem advances. It feels as though someone took a wooden match, lit it, then pressed it against my skim. The burns may throbs. I never had this problem until after "taking care of myself better" by working with my GP starting in 2005.
The burns will often throb in time with my pulse, and may synchronize with points of pain in different locations. The pain is not generally constant, and occurs more often at night. It can manifest from the toetips and up the legs to the waist.
My sugars have been up and down over the past few years in self-comparison. Oddly enough, I feel the burns when my A1C blood tests are higher.

Quantity or Quality?

I refuse to test my blood sugars with home tests and meters.
I do not recommend this approach or encourage others to follow my obstinacy. I am blogging about my own life and experiences. I will detail the how’s and why’s of my situation, but I am not dispensing medical advice here. Constant home testing was necessary as I grew up in the 1970’s, but this was done with urine testing rather than constant blood letting. Standard modern thought is that this can be some 10% more inaccurate than constant blood monitoring. There is additional concern that thee accuracy can be further skewed if the diabetic has kidney damage. I counter this by saying the diabetic should be tested for kidney damage and told how to adjust.
I will get into the reasons, logical and perhaps some emotional, of my opposition to testing in the posts that will follow. Right now, I will outline how I do manage the sugar in broad terms. This is information sharing and not medical advice. Barring digressions and other topics that come up in life, the blog will focus on blood testing issues for a while. It’s a serious and central issue of diabetic "lifestyle" that I feel needs attention and further thought.
The not testing reveal comes with another public confession that I have only really alluded to in prior posts over the past year. My blood test numbers are typically astronomically high. My body operates well and in healthy regards with numbers in the 200’s and 300’s. Tests have shown spikes exceeding 600. At those times, my sugar felt high, but I have suffered symptoms of low blood sugar with numbers in the 400’s.
I know this sounds horrifying to people with even passing knowledge of the numbers game. The target of meter numbers is around 120. The target A1C is 6.5 to 7. Mine have been to 16.
My GP has said he does not understand how I have never been in a coma. Others don’t see how those numbers can be true because I have always been a fit and lean and healthy diabetic. All medical professionals see my refusal to self test and the high numbers as poor blood sugar control.
I don’t agree with the assessments. Not testing by pharmaceutical means is not the same as paying no attention to the underlying condition. I "manage" my diabetes by feel. My emphasis is on how I feel, not what the numbers say. I avoid "high" blood sugar–when it feel high–for the most basic reason: I don’t feel comfortable when the sugar feels high.
Since starting with the GP in 2005, I had several prolonged periods of getting my numbers significantly lower. A1C numbers of 14-16 have gone down to 9, still short of doctors’ targets and always conveyed to me as not enough.
The lower numbers are healthier, I am told. I haven’t been able to believe that, not because I am obstinate, but for a basic, almost primal reason. Every time my numbers get and stay into the "better" ranges, I feel like shit. Clinical depression overwhelms me. I can’t sleep right or function like the dynamo I prefer being. My quality of life feels non existent.
Therein lies the irreconcilable difference between me and my GP. He wants to paint by numbers until he can declare me healthy by statistical standards. I want to feel good. I see little to no value of a prolonged life if it is inescapable, endless days of feeling bad. There’s a quality over quantity issue over which we will never agree.

Rationale and Rationalizations

I don’t test my blood sugars, Instead I pay attention to the indications my body gives, which is a constant process. I will post with more specific details, but this post will I’ve a run down of the rationale and rationalizations behind my seat-of-the-pants management of my diabetes. Please note, as I will explain in more detail, that the "feeling it out" process started by lack of funds, not specific or intentional disregard for medical practice. Nor do I recommend this to anyone, even given my cynical first point. I don’t even claim to be right on this issue. I just know it has worked for me.
I find the home blood testing process to be something of a captured audience racket by pharmaceutical companies. The technology exists for scanner devices that would not require test strips or lancet needles that must be bought for each individual test. The industry has no motivation to make these technologies available as it would mean serious revenue loss for the test strip and lancet manufacturers. It would, however, also mean millions of dollars in saving for medicare and insurance coverages.
I manage by feel. It happened in my doctor’s office that the numbers and the sensations appeared contradictory. As my body went through a relative drop, it triggered that low sugar feeling as it always does. One of the medical assistants ran a meter test and it came out around 400. If there’s any contradiction between the numbers and my body, I’m going to pay attention to my body. It may not look like much, but I trust it.
The finger pricking, and the "other site" poking hurts. The blood letting is far more uncomfortable than the needles used to take the insulin. Unlike taking insulin, test pricks are not strictly necessary for survival.
I do not see how constantly driving needles through fingertips can fail to hasten the development of neuropathy in diabetics. It seems scientifically impossible for the constant poking of the fingers’ and arms’ nerves not to further neuropathy problems via injury and stress to the nerves.
On the same token, it makes no sense to me to warn diabetics about being mindful of cuts or problems on the extremities due to risks of infection, then have them inflict multiple skin breaks per day. Sterilization at the site at the time does not guarantee germs can get in the hole later or that the holes will not reopen.
Non intrusive gauges such as urine testing served diabetics for decades. They are less costly, and obviously would not raise the same profits for the pharmaceuticals.
Tests such as the A1C can guide the diabetic to how he is doing. Yes, there are lab costs involved, but most doctors order these tests in addition to running home meter tests anyway.
In the ultimate equation of time, money and aggravation equation that I run on most anything, the entire process seems wasteful. The benefits to the pharmaceutical companies and those suppliers who ship automatically and bill Medicare such as Liberty Medical seem far greater than any direct benefit I (or Medicare) receive.

Onsets

Another aspect of the Mayo Clinic’s website statement "The A1C test is a common blood test used to diagnose type 1 and type 2 diabetes..." bothers me. Specifically, I do not know that the part "common blood test used to diagnose type 1" is true.
Type two is in many ways a different disease. It’s onset is gradual and the patient can live for years without knowing they have it.
The A1C test measures sugar coating on cells in the blood. This coating forms over two to three months until the coated cells die by attrition. The A1C test can diagnose Type 2.
The onset of Type 1 is not a matter than the pancreas reduces insulin production or the body has increased difficulty metabolizing or using the insulin. In Type 1, the pancreas just stops. There is no gradual development of the condition that would show up in a test that calculated sugar in the blood over time. Doctors diagnose Type I "Diabetes Mellitus" by the symptoms in front of them. A test of the here-and-now blood sugar levels will confirm the symptoms of extreme thirst, constant urination, tiredness, apathy, sweet-smelling breath and a quick question to the patient or hir parents about weight loss.
It seems to me that claiming an A1C test as a useful diagnostic tool for Type 1 is more a matter of running profitable tests.
I could be wrong; this wouldn’t be the first time in life. I am basing the commentary on near-40 years of diabetes experience rather than academic studies telling what tests can be run for information and profit to the industry. But I don’t think I am wrong.
My onset was sudden. I do have memories of the day, true memories, not memories of retellings. I was wasted and drained and had lain down on a picnic table in the back yard and had no interest in being called for dinner. There’s no true or retold memory of a lead in to illness.
The other true diabetes-onset memories are odd snippets. I do not remember the first shot of insulin or blood tests in the hospital.
I do remember my older siblings not being able to visit, but they had been dragged along to wave from the end of the hall of the children’s ward. I remember that because one of my brothers always terrified me and I felt safer knowing he could not get near.
I remember being given tomato juice for the first time and gagging on it in distaste.
I remember playing "Old Maid" with my grandmother. She was sore winner about it, way too triumphant for having won against a four-year-old who had just learned the game. I remember suspecting she cheated. I observations of her character later in life dissuaded me from thinking that even if she didn’t cheat, she would.

Campaigning Conditions

From the Mayo Clinic website: "The A1C test is a common blood test used to diagnose type 1 and type 2 diabetes..."
There is an important aspect to this for Type 2 diabetic and some healthy patients: it is used to diagnose. Over the past decade, the exact number used to diagnose Type 2 has changed up and down several times and is reported inconsistently by different sources. The pharmaceutical companies are involved in that, the same way those companies create "syndromes" such as "restless leg." The pharmaceutical companies are for-profit enterprises that are looking to sell you products, and the lower diagnosis numbers favor their sales. Realistically, how many of us would have heard of things like fibromyalgia if we had not been for all the ads hawking drug treatments? These drugs amount to patented combinations of pain relievers and antidepressants.
If you feel I am being cynical about a serious condition that cripples so many poor unfortunate women, I will steer you towards the latest pharmaceutical ad campaign. The male problems of all aging but not yet old male farts could be "Low T." Ad campaigns like this begin with apparent innocence. You can go to a web site to learn about the condition. The TV ads do not mention the new designer drugs that may solve the problem you did not previously know existed, never mind that the tired feelings and loss of drive may mean that you have this debilitating but potentially crippling condition. Future ads will sell you on the drugs; right now the pharmaceuticals are trying to sell you on a condition. You do have a condition with that tiredness and diminished drive and/or capacity. It’s called old age. Older guys are statistically more likely to carry chromosomal imperfections. Your "Low T" and diminished drive and/or function is nature’s way of making you less likely to share sperm that could produce weak or unhealthy offspring. You can try the drugs, or do what our fathers did: be more physically affectionate with your wife/partner and make sure there’s always a fresh supply of batteries in the house.
In the diabetes sense, the "created" condition is "pre-diabetes." They’re setting you up as early as possible to be receptive to taking drugs in the near future.
In fairness, early detection of Type 2 can prevent devastating ill effects of diabetes. Unfortunately, pharmaceutical profiteers help define the diseases you will soon have.
People need to use their own judgment, and take to heart the catchphrase "when diet and exercise are not enough." Your body very well has the level it wants to be at on its own. Taking drugs will almost certainly change that biochemically, but the pharmaceutical balance sheets may derive more from it than you will, and beginning the drugs too early may make your body lazy with its own functions. If that happens, you are guaranteeing lifelong dependence on the drugs.
I have overweight friends who have low A1C numbers, and fit friends who are told by their doctors that they are pre-diabetic or have "a touch of" diabetes.
Don’t tale my word for this casually, but don’t agree to doctors’ recommendations without asking questions and doing your own research.

Better Living Through Chemistry, Part 1

Diabetes, in my experience, doesn’t directly affect many things. It does, however, indirectly affect everything.
The hemorrhage was in October 2009, but the seeds that led to the hemorrhage had been planted in 2005. After having stumbled across an internist’s practice following a car accident, I looked at it as fate and solution to possible midlife crisis to do as some people urged me by "taking care of yourself better."
As of that time, I was hale and hearty and healthy and had only some mild diabetes related problems only in conjunction with other risk factors.
I had been having the eyeball checked every six months. It looked bad, but my eye doctor at the time–the esteemed Harold Woodcomb–had determined that as bad as it looked, it was entirely stable and did not need laser treatment like they do to diabetics. I lived an active life. I treated the diabetes by feel. I took the needle in the morning and forgot about being a diabetic in favor of a life that rejected notions that as one doctor put it to me "if you’re a diabetic, then you’re not healthy." If the sugar felt low, I ate. If it felt high or I had telltale systems od high sugar, I shot up without hesitation.
The numbers in 2005 were scarey enough that the first lab results prompted a call from a very frightened nurse and a comment from the GP that he did not understand how I had never been in a coma: A1C 15, meter based umbers over 600.
I worked with the doctor to lower the numbers. This was mostly by increased insulin consumption; my diet has always been pretty good.
Thus I began my road to good health. The numbers never got to where the doc wanted them, but they lowered with steady speed and on the inside of a year I could no longer work long days or eventually even very many full days because as soon as I are anything, I crashed. Even a light meal triggered naptime. I would wake up in early evening in bed with no recollection of having gone to bed after lunch.
I no longer felt healthy and the dual high doses of insulin triggered my body on a two-days per day biorhythm.
The lowered blood sugar triggered biochemical depression. I started sleeping 8 hours a day twice a day. My sex drive diminished, with what I recognized as utter lack of motivation, that symptom you hear about in all those antidepressant ads that run constantly on TV, "no longer have interest in the things you love doing."
I mentioned this to my GP. He denied any root cause from depression. Ever willing to promote better living through chemistry and to earn the vacations and perks that ht endless parade of drug reps in his office provide, he gave me a starter bottle of antidepressant and a three-pill sample pack of Cialis.
Thanks, doc.