23: What You Can Expect from Virtually Normal Blood
Sugars / Read
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I am convinced, from my
personal experience, from the experiences of my patients,
and from reading the scientific literature, that people
with normal blood sugars do not develop the long-term
complications of diabetes. I am further convinced
that diabetics with slightly elevated blood glucose
profiles may eventually develop some of the long-term
complications of diabetes, but they will develop more
slowly and likely be less severe. In this chapter,
I will try to describe some of the changes that I
and other physicians have observed when the blood
sugars of our patients dramatically improve.
Most common, perhaps,
is the feeling of being more alert, and no longer
chronically tired. Many people who "feel perfectly
fine" before their blood sugars are normalized
comment later that they had no idea they could feel
so much better.
Another common occurrence
relates to short-term memory. Very frequently patients
or spouses will refer to their "terrible memory."
When I first began my medical practice, I would ask
patients to phone me at night with their blood sugar
data for fine-tuning of medications. My wife, a physician
specializing in psychoanalytic medicine, sometimes
overheard my end of the conversation and would comment,
"That person has a dementia." Weeks later,
she would again hear my end of a conversation with
the same individual, and would comment on the great
improvement of short-term memory. This became so common
that I introduced an objective test for short-term
memory into the neurologic exam that I perform on
all new patients. About half my new patients indeed
display this mild form of dementia, which appears
to lift after several weeks of improved blood sugar.
The improvement is usually quite apparent to spouses.
seem to improve in two phases--a rapid partial improvement
that may occur within weeks, followed by sustained
very slow improvement that goes on for years if blood
sugars continue to remain normal. This is most apparent
with numbness or pain in the toes. Some people will
even comment, "I know right away if my blood
sugar is high, because my toes feel numb again."
On the other hand, several patients with total numbness
of their feet have complained of severe pain after
several months of near normal blood sugars. This continues
for a number of months and eventually resolves as
sensation returns. It is as if nerves generate pain
signals while they heal or "sprout." The
experience is very frightening and distressing, especially
if you haven't been warned that it might occur.
impotence affects about half of diabetic males, and
is the result of years of elevated blood sugars. It
may be defined as an inability to maintain a rigid
enough penile erection for adequate time to perform
intercourse. It usually results from neuropathy, blocked
blood vessels, or both. We can perform simple tests
to determine which of these causes predominates. When
the problem is principally neurologic, I frequently
hear the comment, sometimes after only a few weeks
of near-normal blood sugar profiles, "Hey, I'm
able to have intercourse again!" Unfortunately,
this turnaround only appears to occur if the man was
able to attain at least partial erections before.
If at the original interview, I'm told, "Doc,
it's been dead for years," I know recovery is
unlikely to occur. If testing shows that the problem
was due primarily to blocked blood vessels, I never
see improvement. Note, however, that it's normal to
be unable to have erections when blood sugars are
too low, say below 75 mg/dl.
Another remarkable change
relates to autonomic neuropathy and associated gastroparesis.
I have documented major improvement of R-R interval
studies in many patients, and total normalization
in a few. Along with this, we see reduction in symptoms
of gastroparesis. Usually such improvement takes place
over a period of years. Although it occurs most dramatically
in younger people, I've also seen it occur in seventy-year-olds.
Diplopia, or double
vision, is caused by neuropathy of the nerves that
activate the muscles that move the eyes. It is a very
common finding on physical examination, but rarely
severe enough to be noticed by patients on a day-to-day
basis. Here, again, when testing is redone after a
few years, we find improvement or even total cures
with blood sugar improvement.
Vacuoles are tiny bubbles
in the lens of the eye. They are thought to be precursors
of cataracts. I have seen a number of these vanish
after a year or two of improved blood sugars. I have
even seen the disappearance of small spokes on the
lens that signify very early cataracts.
I've seen cases of glaucoma
cured by normalization of blood sugars.
risk factors for heart disease, such as mild hypertension,
HDL-cholesterol ratios, triglycerides, and fibrinogen
levels, are commonplace. They usually can be observed
after about two months.
in early changes noted on renal risk profiles are
often obtained, usually after one or two years, but
sometimes after a few months.
Most dramatic and commonplace
is the feeling of satisfaction and control that nearly
everyone experiences when they produce normal blood
sugar profiles. This is especially true for individuals
who had already been taking insulin, but appears also
to occur in those who do not take insulin.
Last but not least is the
feeling that we are not doomed to share the fate of
others we have known, who died prematurely after years
of disabling or painful diabetic complications. We
come to realize that with the ability to control our
blood sugars comes the ability to prevent the consequences
of high blood sugars.
I have long maintained
that diabetics are entitled to the same blood sugars
as nondiabetics. But it is up to us to see that we
achieve this goal.