The Good, the Bad, and the Ugly
By Wil Dubois
A dry gust of hot wind churns up a cloud of dust and sand from the dirt street. A tumble weed cartwheels by. Down the street a loose shutter on an abandoned building bangs mournfully. Cue the spaghetti western theme: WeeWe-Woo...wah, wah, wah. On the hill high above the empty town, half grown over with brittle weeds, dozens of wooden crosses stand. Some too sun-faded to read. Welcome to Tombstone.
That's how most people with diabetes picture a dialysis center. Nothing could be further from the truth, both about dialysis centers or about Tombstone. I've visited both places. Modern Tombstone is campy bordering on circus-like, and dialysis centers are clean, sterile, and tend to run on the cold side to keep the machines from overheating. Definitely no tumbleweeds.
But today's column is about how to keep you out of both places. Well. OK, you can go to Tombstone if you really want to. Just be prepared. The OK Corral is just a small dirt lot with some cut out man-shaped wood billboards filling in for Doc Holiday and the rest. But I really don't want you going to dialysis, at least not as a regular guest.
There's a myth that diabetes can do all kinds of bad things to you. It can make you go blind. It can steal a limb. Or two. Or three. It can give you a heart attack. Or a stroke. It can cause your nerves to short-circuit and cause you pain all night and all day. And of course, it can cause your kidneys to fail. I guess that's more than one myth, isn't it?
While all of that isn't really true, like legends of the Old West, there is a grain of truth in these myths. Bad things do happen to people with diabetes. No. Wait. Let me re-state that. Bad things can happen to people with diabetes, but diabetes is not to blame. And I'm here to set the record straight.
If you never learn anything else from me, ever, learn this: Don't blame diabetes.
That's right. Diabetes is not at fault. It's been run out of town by a lynch mob and strung up from a dead tree, but it is innocent of all the horrible crimes it's been accused of. Diabetes causes nothing. What? Oh, right, that. OK, diabetes makes it hard to keep the level of sugar in your blood where it belongs, that's all.
Now, as we've been on a stagecoach all day, just got to town and are hungry, let's find us a cook. And if you talk to an experienced cook, ask her (or him) what happens when...On second thought. Don't ask. I want you to do a little science experiment for yourself. Go buy some strawberries and some sugar. Pour the sugar over the strawberries, add a little water, and stick 'em in the fridge overnight.
But because I really don't want you to leave me and not finish this article until tomorrow (you might get busy and forget to finish reading it), I'll tell you what's going to happen. The strawberries will break down. They'll turn to yummy mush.
Why? Because sugar is caustic. It's like an acid. If you soak anything organic in sugar-water, it breaks down. And you, my friend, are nothing more than a walking pile of organic tissue. Fill yourself full of sugar and you'll break down, too.
So the lesson here is simple. High blood sugar causes all the so-called complications, all the bad stuff that diabetes gets blamed for. Oh, I'm not saying that diabetes actually wears a white hat, but the real villain in the melodrama is sugar, not diabetes. So the recipe for avoiding all our woes is simple: control the sugar, prevent the complications. Actually, that's pretty uncomplicated.
Except for the fact that the relationship between diabetes and kidney function is really is a bit more complicated than that. Sorry. Anyway, as the new sheriff in town, I've been charged with keeping law and order when it comes to your kidneys.
To really appreciate a kidney requires a microscope or a great imagination. Luckily for you, I'm equipped with both. So if you were ever to see your kidneys in front of you, and hopefully this will never happen to you as I can't imagine a healthy scenario where you would, they wouldn't look like much. They're a bit larger than a hard-boiled egg, dark reddish-brown in color, and have the consistency of raw beef liver. Pretty unimpressive-looking for an organ you literally can't live without.
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Many people say that depression is a side effect or complication of diabetes. Without discounting the association of the psychological condition with the physical one, I'm not convinced that our high and/or unstable glucose levels are directly responsible for that change in our mental state. My belief is that the unrelenting need for self-care, for following the sort of care schedules that can drive licensed, professional caregivers crazy, is what overwhelms us...