November 2, 2003
Complications
Question from Rio de Janeiro, Brazil:
I am a 28 year old American living in Brazil who is training in martial arts as an aspiring professional fighter. I have had diabetes since I was 16, and I went through a terrible period in my adolescence and early adulthood taking care of my diabetes even though I had A1cs in range of 7.8-10%. Overall, I would describe my diabetes care as better than average with periods of inconsistency. I take my blood sugars around 10-15 times per day nowadays and around five times per day in my less controlled periods.
In retrospect, I feel I was depressed, felt I would die young no matter what, and I feel as if I gave up. Recently though, my martial arts career is looking very promising and I have become engaged to a beautiful young women. In short, I have an overwhelming desire to live. I am desperate to live well and I want to grow old with my wife to be. I have several questions:
Even though my diabetes control wasn’t great (nor terrible I am relieved to say) I am looking to achieve regular A1cs less than 7% which I have heard is the benchmark for complications. Will a bad start mean it is too late for me to save my body?
Is blindness inevitable for all people with type 1 diabetes? Can laser surgeries prevent blindness in the vast majority of cases?
Are there any good reference books on the specific subject of preventing diabetic complications that aren’t dietary books but more practical guides?
If I achieve perfect A1cs from here on out, can I avoid blindness and/or amputations?
I have done pretty well so far, but I need to know if there is any hope. I need to know so I can find the strength to fight. There seem to be few people who can answer my questions. I await your response with trepidation and fortitude.
Answer:
No, it is not too late to live in a healthier manner. You did not mention any complications. If you have none, you are even better off. The 7% is usually an extrapolation of guidelines that suggest your hemoglobin A1c should be less than 1% above the upper end of the normal range. It has also been the benchmark in several clinical trials evaluating aggressive glycemic control. It is not too late for you to benefit from improved control.
Blindness and amputations are avoidable. You need regular follow-up with an ophthalmologist to evaluate your eyes. Even when retinopathy is present, it can be successfully treated.
There is a series of books available from organizations like the American Diabetes Association which has an on-line catalogue.
You need to make sure you find a physician you can work with. Finding a reason to work harder on your health is a blessing for you. This is good news for you.
JTL
