Lessons From The ER

As a medical provider, I have countless conversations with patients about disease processes, ways they can help themselves improve their health and long term treatment plans. As it turns out, I should have listened to my own advice.

I have a personal story to tell. I truly believe that until we pull back the curtains on the common problems most Americans face and remove the shame associated with chronic disease, we will always struggle as a nation to improve the overall health of ourselves and our families. For this reason I share my story, one that is personal, and at times full of shame and embarrassment but still important to share. As you read this post, please take the time to read the provided links for further information.

At 32, I was recently diagnosed with type 2 diabetes.

Many people think of diabetes as either a disease of children or their grandparents. The sad reality is, we are seeing the diagnosis of type 2 diabetes happening earlier and earlier, even in some rare cases occurring in a patients teen years. For a brief lesson, type 2 diabetes (DM2) is a condition in which a patient sensitivity to insulin is reduced which means their body is making it, but just not using it right (for some common myths, take a look). This is different than type 1 diabetes (DM1) in which case the pancreas fails to make insulin, which is why type 1 diabetics (formerly referred to as juvenile diabetes) are dependent on insulin and most DM2 patients can treat with lifestyle changes, weight and medications if needed.

Before I go into detail on what all occurred at the time of my diagnosis and thereafter, I want to first explain how a person is diagnosed and also what the ramifications are of having the diagnosis of DM2. Initially, there is a usually a trend toward insulin resistance in a DM2 patient. This usually starts a few months or years prior to the diagnosis and labs start showing marginally elevated fasting blood sugars. Anything greater than 100, fasting, is abnormal. Overtime if not addressed with lifestyle changes, the resistance to insulin continues to build until they meet the qualifications of diabetes. One primary method of detection is a test called an A1C. With this testing, and average of a patient’s blood sugar over the last 3 months can be assessed and any reading greater than 6.4 is considered diagnostic for DM2. At the time that the diagnosis is made, the care plan for a patient is drastically changed. Diabetes of any type reduces life expectancy, increases risk for stroke and heart disease as well as blindness, kidney disease, nerve pain and many other complications. For this reason, a patient’s care needs increase with follow up appointments needed every 1-6 months depending on how advance the disease process is at the time of diagnosis. In addition to primary care follow up, many patients are referred to an ophthalmologist for a more comprehensive eye exam (which is repeated every 2 years or more) as well as comprehensive visits with diabetic educators. In addition, some patients require referrals to diabetic specialists, nephrologist and cardiologists. Labs are ordered more frequently and may be done as often as every three months but at minimum every 6 months. Even if diet controlled, it is recommended that patients start monitoring blood sugar and in many cases, patients are started on 3-4 new medications to help not only treat diabetes, but also to help prevent the other organ damage that may ensue.

Life changes and it changes fast.

So what does my story look like you ask? Well, mine starts with a trip to the ER.

I woke one night in early May not feeling well. I eventually made it back to sleep but when I woke the next morning, something was obviously wrong. Now up until this point, aside from obesity and lipid issues, I was relatively healthy. I was not on any medications, did not have diagnosed hypertension and at times had been quite successful at losing weight. In fact, for those that know me, I was at one time about 280 pounds but in 2008 was successful in losing 80 pounds with healthy diet and exercise. Over the years my weight volleyed some but I maintained success at keeping this off until about 2 years ago. Over time my weight ballooned back up to 256 by the time I was diagnosed.

After wiping the happy remnants of sleep from eyes, I felt a pounding in my chest with a pace I was not accustomed to and quickly realized that despite all efforts, I really could not sufficiently breathe. In hopes this would resolve, I got up and attempted to continue my mornings but any effort just brought on intense episodes of dizziness and worsened the beating drum in my chest and shortness of breath. Surely I was not having a heart attack, I had no pain. But I must admit, I kept asking myself if this is what it felt like to have just that, a heart attack. I tried the best I could and got dressed and ready for work. By this time my symptoms had not improved and a check of my blood pressure found it to be 180/104 with my heart rate somewhere around 170, at rest. Something was wrong. However, being the typical American idiot, I decided it would just get better and off to work I went; after all, I was teaching a class today and I couldn’t leave my co-instructor high and dry.

Upon arriving to the classroom, I approached my friend and co-instructor Jan, who happens to also be a medical provider. After a brief description of my symptoms, the dreaded advice came, “Daniel, you have to go the ER. You would tell me the same. I will be fine alone but you have to go, now.” I couldn’t believe it. She thought it was my heart as well. I stood for a moment in a stupor asking myself if all my poor decisions had finally caught up to me. Was that pizza I ate last night the straw that broke the camel’s back (or heart)? I am not one for melodramatics, but at the time, I seriously felt a sense of foreboding. I was uneasy but smiling nonetheless in hopes a smile could diminish the concern and reality of the situation but I was quick to learn that smiles do not cure a disease.

It was a long walk to the ER from where I was teaching but fortunately for me, I was teaching at the Butterworth medical complex in downtown Grand Rapids. As I walked what seemed to be a mile to the ER, I had this sense of panic. I was in a hurry to get there but any exertion only made things worse. I kept wondering, will I make it? And my steadied pace was coupled with obvious attempts to catch my breath making me look the hardest walker you had ever seen. I was running a marathon but at a slow man’s pace.

Arriving at the ER only confirmed my ongoing symptoms. My heart rate was still elevated at 180 and my respirations were only made worse from the trek across campus. This was the start of my stay and nine hours later, I left home with my diagnosis. To make short of my stay, I had labs repeated three times (but six additional failed attempts), an US of abdomen, a chest XR, an EKG, a CT of my chest with and without contrast and countless rechecks of my vitals. Ultimately, I spiked a fever, was given Tylenol and three liters of fluids. My heart rate finally started to come down after the fluids and Tylenol but at time of discharge I was still tachycardic. It is not clear what was causing this but I suspect it was a combination of a viral illness (of which I never had any symptoms of prior to presentation) and my elevated blood sugar.

It was a hard thing to hear and actually, I never did. But I was saying it. One thing to know about the ER is their job is not really to diagnose and cure a patient but rather their task is to ensure that whatever a patient is presenting with is not going to kill them now. Essentially this boils down to whether or not it is an actual emergency and if not, is the patient stable enough to leave and follow up outpatient. Things are only that much better when they can figure it out and treat it with no need for follow up. So in my case, my elevated blood sugar (300 something at the time) was relevant but not life threatening. In addition, ER’s typically do not diagnose DM2 and if labs are elevated but not critical, typically tell patients, “You may have diabetes and need to follow in 3-5 days with primary care.” Knowing what I do, I asked they also order an A1C to see how high I have been for the last three months and found that it was 9.4 (average blood sugar of about 260). I found myself in a weird place. I figured this would happen, I recognized that all evidence pointed to diabetes but at the same time, was in denial. I did, at 32, have diabetes.

It is important to know that this diagnosis was my fault. Yes, there is a genetic predisposition to getting DM2, but when you eat how I ate, genetics had no role. At times my diet probably contained 10,000 calories a day and I am ashamed to say, this was probably the case more days than not. I ate pizza many nights of the week, we ate out often without restrictions and my activity level was comparable to that of a slug. I started wondering about the possibility of having DM2 about a year ago. I noticed I couldn’t sleep through the night without needing to wake to pee and I was having intense episodes of dizziness at random times. Also, Ralphie, our Westie, LOVED to lick my skin…like all the time. I must have tasted like the worlds largest Whirly Pop. I had contemplated checking my labs at work but never did. Although I suspected I had diabetes, I had this false sense of reassurance that if I never really knew, it didn’t exist. I was wrong and learned that eventually your health catches up to you.

I found myself in a unique position. I was now afraid of the very thing I needed to live: food. For me, eating quickly became a source of anxiety. I was not sure what to do. I counsel patients daily about eating healthier, I knew how to do it but for some reason, it was not clear to me what to do and where to go. Overtime, I took control. I looked more closely at labels. We stopped eating out for a while so I could get control of my eating and then slowly started re-introducing dining out, but with less frequency. Today we try to eat at chains which provide complete nutritional information. I cook dinner almost nightly, breakfast on weekends and pack a lunch almost every day. Every day is easier and every day is better. Every day I get better.

So here I sit today. Healthier. Happier. I have since drastically changed my life and worked on a cleaner, more lean diet and increasing my physical activity. Although I am not overtly exercising often (still lacking that motivation to do so for some reason) I have been successful in losing 43 pounds since I was diagnosed. My blood pressure has improved and is now consistently in the normal range and my A1C is down from 9.4 to 6.1 in just eight weeks. In addition, testing showed some damage to my kidneys but with my aggressive lifestyle changes I have been able to reverse this damage and now have normal functioning kidneys. And even better, I have not required the addition of any medications so still med free.

Going forward there is no guarantee that things will stay this good but if I always work to keep my health first and remember that although it may be tasty, it may not do me well. It is my responsibility to change my health, not my doctors, not Ben’s and not my friends. I will always be at risk of developing uncontrolled blood sugars which means the decisions I make today will have lasting effects on tomorrow. Sometimes it is hard but I just remind myself about how I felt when I learned I had diabetes and the fear that consumed me. Remembering the reality I face makes it easier to say no to the sugary treat.