Insulin injection

Injecting insulin, either through an implanted pump or by multiple daily shots, is essential for all type 1 and many type 2 diabetics. Cindi Ross Scoppe/Staff

My ophthalmologist noticed something odd on my retina a few weeks ago. We might not need to do anything, he said, but he wanted me to see a retina specialist. Just in case. He was pretty calm, and I was pretty calm, until our conversation progressed from odd little blips to vascular anomalies to neovascularization and IRMA and then, boom, the dreaded words: proliferative retinopathy.

On hearing the news, my endocrinologist furrowed his brow, doubled my tiny dose of blood-pressure medicine and announced that we would have to get my blood sugar levels much lower.

Retinopathy, neuropathy, nephropathy. Blindness, amputations, kidney failure, early death. I’ve had this parade of horribles recited to me since I was 8. The medical profession quaintly refers to them as “complications,” these life-altering and even life-ending side effects of diabetes.

I’ve always known that no matter how well I controlled my diabetes, there was still a good chance that one or more of them would be in my future. But even after 47 years with the disease, I felt sure they were still in my very distant future.

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Cindi Ross Scoppe

Now, suddenly I was staring one down. Both doctors assured me that even if it was retinopathy, it was early enough that a quick in-office procedure could arrest the damage. Still, it felt like utter failure on my part.

A diabetic can never completely eliminate the risk of complications. But tight glucose control can reduce it, and I could have done more: More exercise, starting decades earlier. A less erratic diet, which would make my insulin needs more predictable. A greater willingness to err on the side of too much insulin. Failure.

I was still fixating on my failure when a news release popped into my inbox declaring that South Carolina was on track to have the nation’s 10th highest rate of diabetes by 2030. It wasn’t really news; other sources say we’re already fifth. But the timing made for a particularly poignant reminder that most people have a choice as to whether they have diabetes, and whether they have to face the prospect of “complications.”

There are two types of diabetes. About 5 percent of us have type 1. Our pancreas stops producing insulin, which is necessary to pull glucose out of the blood in order to feed the body’s organs. Having type 1 diabetes isn’t a choice, although how well we control it is.

Like type 1, type 2 diabetes has a genetic component. Unlike type 1, it also has a heavy lifestyle component. It’s optional.

For more than a third of South Carolina’s adult population at risk for developing diabetes (about 15 percent already have it), it’s an option that needs to be rejected.

Type 2 starts with the body becoming insensitive to insulin, which causes it to produce more insulin, which accelerates appetite and causes weight gain, further increasing insulin production, in a vicious cycle that eventually wears out the pancreas. But it’s a slow process, and you can stop type 2 diabetes before it starts, and often even reverse it, by exercising more, eating a reduced-carb diet and losing weight.

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Diabetes vision

Tight blood-sugar control is essential to preserving the vision of diabetics. Illustration by Cindi Ross Scoppe

I don’t want to suggest that this is easy. In some ways, day-to-day life with type 1 diabetes is easier than avoiding type 2: I can eat anything I want, as long as I take enough insulin. Still, no matter how hard I work at maintaining low glucose levels, those complications are looming.

Obesity and lack of exercise alone can trigger most of the same problems as diabetes. But cross over the line into diabetes, and you turbocharge the risk. Allow the disease to advance, and it becomes irreversible. Then the only way to cut the risk of the parade of horribles is through a daily juggling act of insulin and food and exercise and stress management and several other undefinable somethings that you never, ever, ever get just right. But start soon enough with even small increases in exercise and reductions in weight, and you can turn back the clock, avoid the juggling act and slash the risks.

After weeks of guilt and second-guessing and dread, the retina specialist examined my eyes and declared the anomalies to be simply that: anomalies. Nothing to worry about.

Of course I was relieved. But ... not. Because I know they’re all still out there, waiting for me — the retinopathy, the compromised circulation, the neuropathy, the kidney failure.

Whether they’re waiting for you — well, that’s up to you to decide.

Cindi Ross Scoppe writes editorials for The Post and Courier. Contact her at cscoppe@postandcourier.com, or follow her on Facebook or Twitter @CindiScoppe.

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