I've restarted the blog so that I could include more information, most specifically about Type 2 diabetes, since I'm now a Type 1 AND Type 2 diabetic. Didn't know that was possible? Neither did I! Come find out what's going on at the new blog!
Click this sentence to be taken to the new blog, "Hey! I'm Diabetesing Here: The Revenge!"
It's been a hot second, hasn't it? I essentially ran out of things to discuss. I'm not a doctor, so I'm not going to come rushing back here "With the latest news in diabetes treatments and technologies!" But it's once again time to check in because something old and new is happening.
Go ahead, Rob. Confuse what few readers you have.
I'll start with the old stuff, which involves my diabetic neuropathy. This is some BAD juju. My nervous system is in such rough shape that I can no longer accurately tell what my blood sugar is without a meter. It wasn't as though I could guess a number and have the glucometer confirm it, but I could at least say when I felt high, low, or normal. Now...? I'll feel hyperglycemic when I'm actually normal. I'll feel hypoglycemic when I'm running a bit high. And apparently I've gone as low as 54 without feeling it.
That, my friends, is a dangerous way to live.
For several years, I've griped about how Medicare doesn't cover CGM's. Continuous Glucose Monitors. It was so stupid. Here was a piece of technology that could help us diabetics know at a glance what our blood sugars are before, during, and after meals, which could lead to tighter control, and they refused to pay for it...
...until March of 2022. I found this out when I'd finally lost my patience with not knowing what my blood sugar was doing. This is when my glucometer came back with a reading of 54, and until I saw the number, I had no idea I was that low!
Part of my problem with monitoring my sugars was the fact that the prescription for my testing supplies read that I should check "four times daily." That meant, at the most, I could only check four times a day because insurance wouldn't allow for extra tests. I was determined to send a message to my PCP through the patient portal saying that I needed a new prescription that would allow for testing up to eight times a day.
While typing out my message, I got curious. Off to Google I went to ask, "Does Medicare cover CGM's?" I felt I already knew the answer. "No. Beg all you want, peasant! We only pay for technologies that are around five steps behind anything people would consider 'modern'." So imagine my shock when I discovered that CGM's have been covered since March of 2022!
If I had two feet, I'd have danced a jig!
My message to my PCP was changed to "I need a CGM yesterday!" He agreed. And while he and my pharmacy were jumping through bureaucratic hoops, I learned that I would still need the supplies to test manually eight times a day, just to make sure the CGM was working properly. I would swiftly learn it's just a wee bit more complicated than that.
So now that I have a CGM stuck to me, here's how testing goes:
The thing to keep in mind is that BOTH devices aren't 100% accurate. There's always a miniscule +/- variable that we mere mortals can't calculate. We have to operate on the assumption that the meter is closer to the right number, and therefore we need to "teach" the CGM to close the gap when it reads a wide difference between results.
Now for some confusion... because what would my life be without confusion, right?
I kind of cheated when I sat down to learn how to use my sparkly new CGM. I went to YouTube, found the manufacturer's channel, and watched a few "how to" videos. The video on calibration said to calibrate the receiver every 12 hours. That seemed... wrong. If it was going to have such a wide discrepancy every time I manually checked my glucose, shouldn't I calibrate at that time?
It's my philosophy that "smart technologies" are very smart at all. Do the wrong thing at the wrong time and you could confuse whatever device it is that's supposedly "smart." Without insurance, my CGM costs over $550 for three sensors, one transmitter, and one receiver, so I was afraid I'd break something and wind up having to scrounge up the money to replace it... which is why I called up their customer service line to ask if I calibrated every time I checked my glucose manually, would it... ummm... blow up?!
The simple answer? No. In fact, the CGM seems to be more accurate every time I calibrate it. After four days of correcting the receiver, there's been less and less of a gap.
Going from most recent to most distant, my last four A1c's have been 6.8, 6.5, 6.5, and 6.4. My PCP is starting to think I'm a unicorn, in that he's simply not accustomed to seeing a diabetic consistently stay between 6.0 and 7.0. Why bring those up? Because if I followed how I felt without knowing what my blood sugar actually IS, my A1c's would turn to garbage. Allow me to give an example:
Sitting here, watching a movie or writing a thing, and suddenly I'll think I'm feeling low. That's when I'd reach for something to bring my blood sugar up. I wasn't allowed to check my glucose between meals due to insurance restrictions, so I'd blindly treat what I believe is hypoglycemia. Yesterday, I started feeling low, but now I had the benefit of pressing a button on my CGM receiver, and... Hmmm... It says my glucose is 144. Is that right? Check manually, since now I can check eight times a day. My meter says I'm at 130. I would have eaten something to raise my blood sugar when it it was completely unnecessary! If I did that too often, my A1c would come back indicating that I was losing control of my diabetes.
Also, do you remember my entries that included the Somogyi Effect? Well, now the CGM's alarm sounds when my blood sugar dips in the middle of the night. Unfortunately, the device isn't as fast as I'd like it, so its alarm will go off repeatedly while I'm treating my hypoglycemia. I wish there was a way to teach it patience. Like, "Dude, cool pits. I'm working on it. How about you learn how to alert me when my sugar's reaching a normal level?" Alas, I fear I'm asking too much.
So, my friends, we've reached the conclusion of this latest adventure. This is usually the part where I put a picture of a beautiful woman and claim that she's my wife. Alas, todays human female is FAR TOO YOUNG. Take a look...
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For reasons beyond my understanding, my Facebook feed will throw suggestions at me, trying to catch my interest. Their suggestions are usually WAY off. Then one fine day, FB suggested little Faye, here. What captured my attention immediately was her massive wealth of hair! There's just so much of it! It's crazy! As I understand it, her hair has never been cut. Trimmed, perhaps, but never outright cut. So she's been growing that mane since birth! She's youngest and smallest of some youth acting/dancing troupe. (Apparently she's 10 years old and about 4' 6".) She has an Instagram account if you want to learn more about her. Just don't be weird about it, okay?
Still, I can't end my post with stuff about a little girl with enough hair to play Medusa in the MCU. How about bringing back a classic?
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Hey, I sent her the divorce papers! "Jane Douglas, Somewhere in the U.K., possibly near London." Since she hasn't sent them back, I'm assuming she wants to remain married to the walking, talking wreckage that is me. If she wants out, she can send me her exact address. 😁
Does that sound absurd? It should, because it is. And I've done it. Multiple times.
Like today. I wrote about the Somogyi Effect and how I thought I had a handle on it. Yeah, not so much. The good fasting blood sugars are rarer than the ones that are utter garbage. This morning, I woke with a glucose of 403. FOUR HUNDRED AND THREE! You must be thinking, "What on Earth did you eat last night, Rob? An entire chocolate cake?!?" No, my evening snack was a couple of microwave chimichangas, a total of four carbs on a diabetic exchange diet. (Not to be confused with 4 grams of carbs.) My glucose at the time was 126, so I took only enough insulin to cover the meal. My thinking was that if I tried to add just a little more insulin to bring my glucose closer to an idyllic 100 that I'd be risking the slingshot effect of a Somogyi. For all of my careful thinking, I got a fasting glucose of 403.
I had - past tense - a podiatry appointment this morning. I'd just seen my podiatrist nearly two weeks ago, but was still experiencing a bit of pain. When you have advanced Diabetic Neuropathy, a "bit of pain" could be an indicator that something is very wrong. Mind you, the pain has diminished since I called to make the appointment, but I was still going to get it checked out. Better safer than sorrier.
The problem is that I can't go to a doctor's appointment when my blood sugar is so high. I need to monitor it. Take extra insulin if necessary. Be around food in case I overcompensate with my dosing. If I had a Continuous Glucose Monitor (or CGM), this would be less of a concern, as I'd know what my glucose was doing with the application of an app on my phone. But Medicare doesn't cover CGM's. As a result, I called in sick to a doctor's appointment.
The greatest culprit when it comes to missing medical appointments has been my Diabetic Neuropathy. The burning sensation in my skin would make it impossible to wear clothing, since contact with even the softest material would make me want to cry. This wouldn't be a problem if I could just go where I needed to go without a stitch of clothing on, but not only are there laws against that, but no one - and I mean NO ONE! - wants to see me naked.
I sincerely wish people would leave comments to let me know if these lessons and stories are getting through to them. I see some people are reading these meandering musings of mine, but I have no idea what effect I'm having. And no one who's read my last entry has donated to my GoFundMe. (Please, if you can't give, share the link. The sooner I meet that goal, the sooner I can stop worrying about this.)
Anyway, we're nearing the end of my post and I haven't posted a picture of my new wife.
That, my friends, is English actress Jenna Coleman. As I did when "married" to Jane Douglas, I sent divorce papers to Jenna so that she might escape her relationship with me. It's only fair, right? Alas, an address of "Somewhere in England" probably won't reach her, so she and I will remain a wedded couple... until some other beauty catches my eye and I declare that one my bride. What can I say? I'm capricious.
Until my next post, whenever that may be.
"Woooow! Rob came back and wrote a post. We thought he died or something."
Not quite yet. I was recently talking with a friend about how it's miraculous that I'm still alive. I mean, around a decade ago, I was on the phone with an old friend, and after telling him all of the crap that had been going on in my life at the time, he said, and I quote, "It's amazing you haven't committed suicide already."
That's what I get for dialing in to a discount therapy session with Pep Talks-R-Us.
This blog post is so I can share my GoFundMe page. This is, in a way, a continuation of my post about my dental issues, except that I'm now asking for financial aid to get dentures.
I'm sure I've discussed this before, but diabetes control is about balance. Diet, exercise, and medication need to be balanced carefully... except that exercise for me is next to impossible. The strength in my hands is negligible due to atrophying muscles. The bones in my remaining foot have fused, and continue to fuse, creating an appendage that's not terribly useful. Without exercise, I have to maintain control with insulin and diet, and diet is going to be EXTREMELY difficult to maintain without teeth.
By the way, my last post mentioned two teeth that don't move when nudged. I actually tried to convince the dentist that if I could keep those two teeth, my future dentures would TECHNICALLY be partials, which would be cheaper. However, the gums are receding around those teeth just as much as everywhere else, putting them at risk for serious gum infections.
Remember my post on 10 November 2022? No? Well, of the four teeth I had removed around that time, one had broken off, leaving fragments behind. Infection had set it. SERIOUS infection. It was so badly infected that the dentist couldn't numb the site. When he went to grab what was left of the tooth still embedded in my gums, A LOT of pus came bubbling out of the sides. It was a real mess.
So all of my teeth need to go. But because diet and medication are the only two things allowing me to maintain control of my diabetes, I NEED teeth.
For all of the times I've had to beg for financial aid, this is the first time that it's not an emergency. The extractions will begin on 9 May 2023, and that's just the beginning. There'll be another two or three extraction sessions after that. And that means there's plenty of time to reach my goal of...
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Yeah. Sure. That's a perfectly reasonable goal. All I need is one million people to donate $1.00 and I'll be all set.
Seriously, I set the goal at $1,600.00 because that's what it will actually cost. But if there's a millionaire out there willing to throw money at me, I won't complain.
Clicking on this sentence will bring up my GFM page. (Yeah, I linked it twice. Desperate times, desperate measures, etc.) What I'm actually asking for is maybe $5.00 a month for the next six months or so, which should help me meet my goal. If you can't afford to help, just share the page with friends and family. Every little bit helps. And although I'm not in a rush, the sooner I meet my goal, the sooner I can stop worrying about it.
That's it, folks. I came to my blog to plead for help. And if I manage to think of a diabetes topic I haven't already discussed, I'll come back to post about it.
If you go waaaaay back to November of 2022, you'll see a post, "Dentist!" It was quite the experience, and I decided I'd had enough of these oral adventures. It was time to see the dentist regularly. I could at least bite things with my front teeth and chew on the right side of my mouth; I should try to keep the teeth that remained. Thus, after that agonizing visit, I scheduled a cleaning.
But in case you haven't been paying attention to my stories, "Life is what happens while you're busy making other plans." That John Lennon quote fit my "cleaning" visit to a tee. Y'see, there's been quite the build-up of calculus around my front teeth. Yes, calculus. "It's not just math!" Calculus is hardened deposits of plaque.
Okay, let's back up. When my left foot was amputated, I went six months without taking even minimal care of my teeth. I was so overwhelmed by my struggle with all of the other forms of bodily maintenance that my teeth were ignored. That's when the plaque started building up. Once it had a foothold... (A foothold in my mouth? Weird.) Once it had a foothold, the plaque continued to build-up, even when I started brushing regularly again.
Following so far? Good. Because now we have to add other complications to the scenario.
I didn't need a professional to see the rather extreme situation in my front teeth. My gums had been pushed way down, with a lot of calculus at the base of the teeth. Even with that hardened substance's presence, my teeth could be wiggled with just a gentle nudge. Which led me to ask, "If you clean away the calculus, will my teeth just fall out?"
Y'know, it's a little sad when the dental assistant working with you gets excited that YOU reached a conclusion before they could mention it. The dentist was proud, too. And the answer was, "Yes." I asked if they could at least clear away the calculus that would lead to painful gingivitis, and they said my teeth would likely fall out if they did that little bit.
So what? It's a tooth. If it looks like the plan is going to be a complete removal of all teeth, what's the big deal if some fall out?
Oh, nothing special. Just an increased risk of infection because - you guessed it - diabetes.
By the way, that was the plan we discussed. My gums had seriously receded, even where there was no calculus. All but two of my teeth moved when nudged. Things can get caught in teeth that are as loose as mine. Those things can lead to infection, and often do. I have to lose the teeth. All of them.
This news coming on the heels of the EMG results has knocked me flat mentally. Well, not just this, because Dunder Klutz here stumbled after a shower, and my foot smashed into the rather sharp corner of a shelving unit in my apartment. To be specific, it was the inside of my foot, where a particularly large callus resides. Well, resided - past tense. I didn't think much of that collision... until I spotted the blood stains in my carpet. Seems that after my shower had softened that callus, the impact sheered it off, leaving me with a bloody mess of a wound.
So... Very little muscle left in my hands... Serious wound on my foot that I didn't feel, thanks to diabetic neuropathy... I have to lose all of my teeth... Yeah, I'm feeling the weight of existence more than usual. What's more, I'm going to need dentures and I can't afford them. So what if I'm a diabetic that needs to eat? I could live on mashed potatoes and peanut butter, right? I'm going to have to beg and plead with friends to help me get prosthetic choppers, since Medicare doesn't offer dental insurance.
~as sarcastically as possible~ Life is just grand.
Let's change the subject entirely. Remember when I advertised the scantily clad young woman? Well, this isn't her:
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This gorgeous young woman is Rachel, or Keet, as she often says very quickly at the start of her videos. I think she's only 17 at the moment, but I could be wrong. She has a rather serious case of Tourette's Syndrome. Her tics can be quite entertaining because her voice pitches up when she experiences echolalia. She sounds adorable! But she's suffering. She has no control over the sudden movements or outbursts. She posted a video that was only a small portion of a four-hour tic attack. If you want to follow her, then I'll link to her TikTok. But behave. She's underage. She's been bullied. She's been accused of faking. She'll continue to experience these things from a variety of jerks for the rest of her life. Don't be a part of that. Listen to what she has to say and bask in her beauty. Don't be mean or creepy.
Probably more than me, anyway.
Yes, it's been a minute since I've written here. I blew a mental gasket, followed by the realization that I'd run out of things to discuss. I mean, it's a blog about diabetes. To come here and rant about politics or religion would be inappropriate. "In my next post, I'll tell you about my favorite science fiction novels." Not what this blog was created for.
Yesterday, 28 February 2023. however, brought something old/new to my life: confirmation of how bad my neuropathy really is.
Now I know it's been bad. In the last decade, I've gone from calling it "diabetic neuropathy" to "advance diabetic neuropathy." That's because of the diagnosis of Charcot foot. It takes a lot of nerve damage for bones to start drifting, suffer minor dislocations, develop microfractures, and eventually start fusing together. For some reason, knowing all of that didn't upset me all that much. It was an inconvenience. It sucked. But it had next to no emotional impact.
Yesterday was different. I went for a test called an EMG, also known as an Electromyography. Oh, if you're not taking care of your diabetes, get ready for this bundle of fun! They place a few sensors in various spots, and then send a pulse of electricity through specific points to measure the nerve and muscle responses. The test has two parts. The first is when they deliver little jolts through the surface of your skin. The second involves inserting a needle to measure electrical activity in various muscles.
The doctor and nurse would say late in my visit that I was their most fun patient. I tried joking about everything. For example, the doctor was Muslim and I was brought up Jewish, so when she had to deliver a particularly painful jolt several times, I blurted, "This is because I'm Jewish, isn't it!" And during the surface shocks, when the nurse was getting no responses, I had a whole shtick about the doctor berating her about wasting time by running the test on a corpse. "Living patient is in room two. Dead person room one. Go test living patient." (I used a Russian accent. I don't know why.)
Those lack of responses... When the nurse had to turn the electrode all the way up and was barely getting a response... I may have been making jokes, but jolting a nerve that hard and seeing a flatline was bad news. I'd had this test in the past and can't recall it ever hurting. I believe they use microvolts. When cranked to 100 and shocking the nerve several times, only to see nothing on the graph was disheartening.
Usually when I go have tests like this, I'm out the door when they're done and I get the results some time later. Not this time. The doctor was able to tell me that, yes, I do have carpal tunnel in my right wrist. Whether or not I'd benefit from surgery would depend on an orthopedic consult. As for my diabetic neuropathy... It's bad. Very bad. The doctor said, "There's almost no muscle left," but then immediately corrected herself, "Well, there's very little muscle left. You obviously still have enough to move your fingers."
You obviously still have enough to move your fingers.
There's some Stephen King levels of horror in that statement. Have you seen The Shawshank Redemption or read Rita Hayworth and the Shawshank Redemption? Those don't seem like horror stories, do they. You have to consider the author. King often seeks to find the worst fears a person could think of and use those fears as the basis for stories. Imagine being in the wrong place at the wrong time, with circumstantial evidence stacked against you, and because the shock of events has caused you to shut down emotionally, you seem cold and uncaring during the murder trial. A murder you DID NOT commit. You're found guilty and shipped off to prison, where you're promised three hot meals a day, a bed, and a whole lot of new friends you'd run away from if you had the opportunity. That's terrifying. That's what "Stephen King levels of horror" means.
You obviously still have enough to move your fingers.
Imagine the alternative. "You don't have enough muscle to move your fingers properly anymore." To an extent, I'm already there. Holding out my hand, fingers straight and held together, you'd notice that my pinkies and ring fingers on both hands can't close the space between fingers completely. When I struggle to try to make them do what I want, the fingers tremble feebly, refusing to do what my brain is telling them to do.
Dead muscles. Immobility. The muscles have atrophied, not because I was inactive, but because my brain couldn't stay in touch with my muscles.
The doctor DID compliment me for taking steps some time ago to find a fun way of working my hands as a form of physical therapy. I bought 460 2x4 Lego bricks for somewhere around $30. Almost every day, I take apart the last thing I made and build a new thing. Think there isn't much to be built with only one type of brick? Let's take a look.
You might be wrong.
So that's about all I have for the moment. This realization of exactly how screwed my hands are has been emotionally draining. And until I think of something more to say, or someone actually asks me a question about diabetes, this blog will return to it's suspended animation.
I might was well embrace the madness and go completely off the rails.
You want to know the greatest problem with my diabetes? Me. ME! As vague as the warnings were, I didn't listen. "You could go blind." "You could lose both of your feet." Those were the two I heard the most. They would have had more impact if they'd included HOW those two things would happen, but they should have had SOME kind of impact.
Yeah, my home-life was crap. (Yeah, I'm abandoning my PG-13 stance for the moment.) A lot of people's home-lives were crap. That the incubator was especially psychologically abusive was probably the worst of it. And you wanna know what makes that worse? It was recognized very early on that I was having emotional difficulties, and school officials urged my parents to seek psychological help.
They did. And the incubator screwed that up BIG TIME! You see, the first psychologist ran a bunch of tests, and then sat my parents down to discuss the diagnosis. Said diagnosis was that I, at the tender age of eight years old, saw the incubator as a constant threat to my well-being, always looming over me, waiting to strike. Well, the incubator became highly offended by this. She was the perfect parent, and if you didn't believe that, you could just ask her and she'd tell you.
Off we went to a second psychologist. That one also ran a bunch of tests, and then sat my parents down to discuss the diagnosis. Said diagnosis was that I, at the tender age of eight years old, saw the incubator as a constant threat to my well-being, always looming over me, waiting to strike. Did she take the hint? Hell no! Did my father take the hint? If he did, he didn't want to deal with the fact that his wife was the problem, and so...
Off we went to a THIRD psychologist. This time things went differently. The incubator complained in advance about the two identical diagnoses that she thoroughly disagreed with, So Dr. Greedy came back with a diagnosis that said she was perfect, and that the problem was all in my head. "Come back weekly and we'll get him all sorted out."
Yeah, the bitch shopped for a diagnosis she preferred and ran with that instead of making any kind of effort to fix was was actually broken.
I was off to a miserable start, what with me only being a year into my life as a diabetic. And it seemed like her mission in life was to make EVERYONE miserable.
The best example of how bad things were at that place where we lived, (which was far from a "home"), was when we went to family therapy during my mid-teens. Shockingly, it was with Dr. Greedy, who by this point I knew to be a dumbass with a PhD. I complained about the incubator. My middle brother complained about the incubator. My youngest brother complained about the incubator. My father complained about the incubator. So what did the incubator do? She became angrier, more contentious, more bitter, more combative. She did no self-reflection whatsoever. We were "ganging up on her," and that made US the villains of the story.
Other kids during their rebellious years... They started doing drugs. Others would start drinking. My grand attempt at teen rebellion was to down a pound of Twizzlers while reading a Stephen King novel. And because an insulin dose at each meal was still decades away, I'd get sick. Every two or three weeks, I'd wind up in the emergency room. I lost count after 50 hospitalizations.
Remember me saying how depression comes with chronic illness? Life with the incubator only made that worse. The way I describe it is thus: "The valve that releases the negative neurochemicals that cause depression were jammed open by that abusive cow, to the point where only medication will help control it now." I also mentioned in a roundabout way that I'd recently fallen off my antidepressants. I've started the process of getting back on them, but...
Understanding my disabilities isn't easy. It wasn't understood for quite some time. Because at the time I was declared disabled, I didn't LOOK like I had health issues. You can't see severe recurrent depression. You can't see PTSD. You can't see the complications of diabetes until a foot comes off or the afflicted individual is using blind mobility cane or has a seeing-eye dog. I'd say 95% of the family members I was talking to at the time all started telling me that I wasn't sick. That I was lazy. That I just had to snap out of it. And when I did unacceptable things at the height of my mental illnesses' effects on me, they vilified me and cut me off.
My youngest brother grew up to be a fill-blown racist and misogynist. Oh, the stories I could tell about him! He's a selfish prick who only views people through the lens of, "What can they do for me." So when my father got remarried at age 69, my brother's response was, "Now there's ANOTHER person to divide the inheritance!" Translation: He was waiting for my father to die so he could get the life insurance money. Well, Dad fixed that right away, removing my brother from his will and disowning him.
My middle brother grew up to be a clone of the incubator. When his one and only child was diagnosed as clearly being on the Autism Spectrum... Okay, when my brother was telling me this, his son was in the room. When he got to his thoughts on the matter, he looked at his son and raised his voice to say, "He's just being lazy!" My brother has vanished completely. I have no idea if he's dead or alive. We have a few mutual friends, and just like me, they haven't heard from him in over five years.
I went on quite the tangent there, didn't I? I was saying that I fell of my meds and am in the process of getting back on them, but it wouldn't make much of a difference. I always get depressed around the holidays. Part of that is the fact that Dad used to send me a gift twice a year. Once on my birthday and once during the holidays. It was always $25. In his final years, he couldn't really afford it, and I wasn't in desperate need, so I'd thank him, and then would quietly tear up the check. Thing is, now I AM in need, and Dad's been dead for many years.
So I debased myself. I actually went on Facebook as asked my friends for gifts. Specifically ONE gift. I asked each of my friends to spend $10 on a PlayStation gift card. Not a lot of money. I keep thinking of $10 as being the most anyone would ask for during the office's Secret Santa. If just 20 friends did this, I'd have more than enough to buy those games I keep putting on my Wishlist. What's more, they just have to send me the code through a private message or email. No postage necessary. And knowing they did this little thing for me would help boost my battered and bruised ego.
The problem is that I have to ask. No one gets me gifts because they thought of me while shopping. I have to remind them that I exist and that a small gift would make me feel better about myself. Will I return the favor? If I could, I would. I mean, if I... Hang on...
If I won a stupid amount of money in the lottery, every single one of my friends would receive that maximum amount of money permitted without requiring them to report it to the IRS. For 2023, that amount is $17,000. Annually. Just a little leg up to do with as they pleased. What's more, they wouldn't have to ask. I'd ask for addresses, and then checks would be mailed out ASAP. Their kids would always get gifts from "Crazy Uncle Rob" during birthdays and the holidays.
I have to ask for presents. Small presents. And when I last did this, during my birthday over the summer, three people gave me gifts. Three.
Y'know, it's almost like I'm just too much to handle. Why? Because I'm so broken, physically and mentally. For the latter, I'm going to fall of my meds every now and again because it's the nature of the beast. But the former...? I did catastrophic damage to myself and I KNEW it... I just didn't care. Not until it wrecked my life.
Okay, I think I'm done ranting now. Here's another picture of the beautiful, scantily clad young woman to make up for my rambling.
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Today makes it two weeks since anyone's read this blog. It wasn't exactly breaking any records to begin with, but the analytics say there've been zero views since my 20 November 2022 post.
Someone nudge me if you're still interested in what I have to say about diabetes. Until then, I'll keep to myself and randomly check in to see if anyone even glances at my last two posts.
Hey, y'know that disease called diabetes? I certainly HOPE you do. This blog has been all about that silliness. Well, I've mentioned at some point or another that mental illness comes with chronic illness. It's part and parcel for the whole thing. And usually that mental illness is depression. "Why me?" becomes something you ask consciously or unconsciously almost every day. And, boy-howdy, does it suck! What I find most odd is that it's not called "diabetic depression." They tack "diabetic" on as a descriptor for almost every other thing that comes with the illness. Why does depression get left out?
After 48 years of Type 1 diabetes, I practically do everything required to maintain it as though I'm on autopilot. I've set alarms to keep me on that schedule I mentioned last post. When one goes off, I stop what I'm doing, check my glucose, take some insulin, eat a meal, and then go back to whatever it was that I was doing. (Performing these rituals is how I wound up turning "diabetes" into a verb. "Hang on a sec. I have to diabetes.") It's barely an existential speed bump in my day.
But staying on top of my OTHER medications... I wish it was that easy. Get the pills and divvy them up into the three-week pill container I have every third Saturday. This seemingly simple task becomes so arduous in my head. That's my severe recurrent depression in action. And so I fail to get that pill division done, fail to take them regularly, and before I know it those medications have lost their efficacy.
The big one... Well, antidepressants need to be built up to their therapeutic level. It takes four to six weeks for that to happen. What's more, the full dose shouldn't be given at the start. You have to build up to that dose. So it's 10 days at half a tablet to start, 10 days at a full tablet for stage two, and then another 10 days of one and half tablets to reach the full dose.
That said, my pill container only handles three weeks at a time. So I'm still struggling to reach that therapeutic level when it's time to refill it, and... "Oh, why bother? It doesn't matter anyway. No one really cares about me, so why should I work so hard at setting up my pills?" Yeah, that's my depression still holding sway.
I'll let you in on a little secret. I'd say 99% of this entire blog has been written while under the harsh effects of my mental illnesses.
Oh, yeah... Severe recurrent depression isn't my only psych issue. I'm also dealing with PTSD, which is the culmination of several events that either keep me awake all night or make me jump out of my skin while letting loose a scream of terror.
This morning, after taking my 24-hour insulin, (which only works for approximately 20 hours), I looked over at my empty container of other daily meds and... I just wanted to cry. Accompanying the urge to let the tears flow came the fun and exciting thoughts... "I don't care. It's not like missing those meds will cause me to suffer a painful death. Well, maybe my heart meds. I hear heart attacks are pretty painful. But maybe I'll get lucky and have one of those 'instantly fatal' heart attacks. The end. I can stop worrying about... well, everything. No bills. No scheduled medications. No having to put on an act so people think I'm happy and friendly. It can all just end and I can finally get some rest. And who knows? Maybe Heaven, (which I don't believe in), is as depicted in Supernatural. Everyone's Heaven is different. In mine, I'll be fit and healthy... and I'll be younger... and there'll be girls, and movies, and girls, and video games, and girls, and good food, and girls, and visiting D&D nerds to play with, and girls, and comfortable clothes, and girls, and really nice furniture, and girls... Yeah, staying alive is for chumps."
Looks like nearly five years of being a bachelor is having a bit of an effect on me.
Such thoughts then begin to spiral. What comes next? Approximately 1,000 regrets from my decades of life come to mind. As I dwell on those, the short list of girls I had SERIOUS crushes on in high school pop into my head for a soul-sucking visit. And, hey, while I've got high school on my mind, how about remembering all of the abuse I suffered at the hands of the incubator? Oh, and here's a favorite memory: that job I absolutely LOVED and busted my butt to become an assistant manager, only to be rejected because I didn't suck up to the district manager, and the final result was him not only telling me that I did NOT get the job, but then gave me an absolutely insulting raise of $0.05 per hour for all of my hard work. Makes me wish I'd beaten him with a sack of hammers instead of quietly walking out of his office.
My mind is a playground for the morbidly obsessed.
I don't know if I've mentioned this previously, but I once told my doctor that I'm simply waiting for death. It's not that I'm actively suicidal. I just don't care anymore. And as I wait to shuffle loose this mortal coil, I don't want things to hurt. That's it. Like self-imposed palliative care, I just want to be comfortable while awaiting my demise.
That's why I take such great care of my diabetes. Because NOT taking care of it is a bad way to go. Too much discomfort.
The best part...? The cherry that sits atop this existential sundae made of psychological garbage... is that the complications of my diabetes are constantly reminding me that I could be so much healthier if I'd taken proper care of myself from the start.
Now... Who's in the mood to party?
No one, eh?
Okay. Maybe it's time to end this post. And to lift your spirits, here's a sign that should have mentioned juvenile diabetes instead of... Well...
I'll start with an apology. I'm sorry if you feel left out. When I speak about bending the rules of a diabetic diet, many of you can't do what I suggest. You're probably on oral medications and a far less forgiving diet.
Or are you?
Okay, let's start with my repetitive reminder: I AM NOT A DOCTOR! I've read a lot of stuff. I've made some reasonable leaps in logic. I have decades of experience as a Type 1 diabetic. So if you read medical advice from me and act on it without consulting your doctor, that's on you.
With that said, maybe you should have a sit-down with your doctor and ask if moving from oral meds to insulin injections would grant you more freedom. Obviously it would best if you simply followed instructions. A large portion of Type 2's are overweight, and the best course of action would be to lose weight. But that's a big ask when you're older and so out of shape that diet and exercise look like an insurmountable task.
Mind you, my first instinct is to tell you to try and lose the weight. No, it's not easy. But if you can afford to buy healthier foodstuffs, then please give it a shot. Because if you succeed, you'll get the natural high that comes with achieving a difficult goal.
If your doctor agrees that switching to insulin would be better for you, you need to understand that you cannot take this change lightly. You're not on the strictest timer in the world, but you better have a scheduled range in place of when to take your insulin regularly. Here. Have another list, this one of the time ranges for my insulin doses.
"Wildcard." This is my only one that isn't scheduled all that strictly. That's because bedtime could come between 10:00 and 1:00, and there's a sizeable gap between that dose and breakfast. But this is the dose that I'm the most careful with. No cheating with my evening snack. If you read my post about The Somogyi Effect, then you already know this dose is a balancing act. As careful as I am, I still manage to screw it up quite often.
The main point is that you have to take the switch to insulin VERY seriously. A poorly planned meal or dose could see you struggling with glucose readings that swing wildly up and down.
Let's look at two different dates on my glucose records.
The first is the day after I saw my doctor to receive a steroidal injection for, of all things, tennis elbow. How'd I get tennis elbow? No clue. I don't even know where a tennis court might exist where I live. But steroids do goofy things to one's blood sugars, so this is what 12 November 2022 looked like:
That was a rough day. I struggled all day to get my blood sugars in line, and was only partially succeeding toward the end of the day.
Now let's look at a more typical day. This is 22 November 2022.
Timing. Care. Awareness. These are things that you need to keep in mind when taking insulin.
I have a friend from way back in high school that became a Type 2 diabetic, and he's on insulin now. He tells me how he takes 2 or 3 units per meal, and the tone of my voice switches to that of an adult addressing a child. "Awww, wook who's a big boy, taking his cute wittle insuwin dose." But that small dose is exactly what he needs to keep his glucose levels in line. Does he have it down perfectly? No, but he's trying. I think he said his last Hgb A1c was around 8.0, which isn't good, but far from the worst I've ever heard.
In my educated OPINION, your A1c is going to be your biggest indicator as to whether or not you should be on insulin. If oral meds aren't keeping you between 6.0 and 7.0, then your control might tighten up a lot more with insulin. TALK THIS OVER WITH YOUR DOCTOR! My "educated opinion" means squat because I don't know your medical history, and I haven't been to med school.
And so we come to the close of yet another blog post filled with what could be excellent advice, or some of the dumbest words to ever come out a guy who thinks he's smart.
I think it's time we brought back the beautiful scantily clad young woman that I used as my shtick in my earliest posts. But this time...
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But this is as scantily clad as she ever gets. If you want more of my opinion about her and her "modelling," you'll have to ask. And we all know how that one will play out. 😛
Okay, confess. How many of you Googled "kewpie doll" after the last post? C'mon, don't be shy. "I won't point and laugh," he said, pointing and laughing.
This blog about diabetes has been focused on a lot of doom and gloom. You shouldn't do this! Don't do that! You need to worry about the other thing! It really sets a person up for Failure Mentality. That feeling that the goals set in front of you are impossible to reach, so you might as well give up and embrace oblivion.
First, let me revisit the fact that diabetes is a pain in the butt. You have to keep an eye on your blood sugars, take your medication in a timely manner, and see your doctors regularly. There's also a lot of information about the disease that you should keep in mind. If you're young and relatively healthy, you have to think about how something like a lengthy bike ride might affect your blood sugar. If you're older and less mobile, like me, then you're trying to calculate the exact dose of insulin to take with every meal, because changing up our carb consumption is going to be too difficult at this late stage. Without a doubt, it's a mental juggling act.
Unfortunately, you can't ignore those aspects of diabetes. If you do, then feel free to reread all of the aforementioned doom and gloom, and then brace yourself for them to become a reality.
But if you can get a handle on your diabetes and keep your Hgb A1c between 6.0 and 7.0, then you have wiggle room to live a little more freely. Because truth be told, I'm a diabetic with a sweet tooth. And I cheat on my diet DAILY!
"You want to know what the best junk food is? Ask a diabetic." I have been telling people this for decades. My latest favorite cheat? Cinnamon bears. Soft, chewy, tongue-tingling cinnamon bears. Mmmmmm! I could probably sit to watch a movie and polish off an entire bag.
But I don't. I can't. WE - you and I - CAN'T. That would be a guaranteed visit to the hospital, as well as the extreme discomfort of being sick enough to land there. So how do I do it?
I start with the near-ancient diabetic exchange diet. 15 grams of carbs = 1 piece of bread. I take a fixed number of units of insulin for each "bread" that's in a forthcoming meal. So if a label says there's 46 grams of carbs in the meal, I'm multiplying my dose per carb by three. (I'm not sharing actual numbers because I am EXTREMELY insulin resistant and take A LOT of insulin.)
If you're not seeing how I cheat, then I'm getting a solid gold kewpie doll and dropping it on your foot.
Okay, I'll explain anyway.
My dietary cheating comes with meals, and ONLY with meals. Taking randomly timed doses of insulin throughout the day is a quick way to wind up in a diabetic coma. (Have I even discussed insulin peak times? Let me know.) (See what I did there? I made a funny. Because no one comments. Ha-ha.) Having read the labels of my upcoming meal, I also read the label of what I want to cheat with. Those cinnamon bears of mine are pretty big, so three of them equals 22 grams of carbs. Six bears will be close enough to 44 grams, so I add three more "breads" to my insulin calculations. Now I'm all set for a meal and some dessert.
"But Rob... What if I'm out to eat with friends and want some cake or ice cream after a meal?"
If you're keeping your A1c between 6.0 and 7.0, then you know your body pretty well. For a small serving, take at least enough insulin to cover one "bread." For larger servings, make it two. Later on, when it's time for that final test of the day, take a dose that covers any potential fallout from your cheating session.
Now that I've taught you all how to cheat on your fairly strict diet, let's get a few things straight.
I think that covers all I have to say on the subject of cheating on a diabetic diet. So now it's time for the glorious ending of my post, where I say or do something silly.
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Once you've managed to mismanage your diabetes long enough, everything medical is almost assured to be a lengthy drama. It's the nature of the beast. The main culprit is going to be all of those microvascular structures that have been effectively strangled by sugar.
Have you guessed where I'm going with this? Are you guessing, "infection"? If you are, then you win a kewpie doll! And if you asked yourself, "Is this another dentist thing?", then you'll find a silver nugget inside your kewpie doll!
I'm an absolute stickler for following a doctor's instructions. So when all of those teeth were removed, I avoided solid foods, carbonated drinks, using a straw to drink (like that was something I did regularly), and rinsed with warm salt water post-extractions.
Here's the thing... Humans are inherently dumb. We do dumb little things regularly. When I'd swallow, my tongue would press against the hard palate of my mouth. Doing so made the point where the front tooth had been removed hurt intensely. So what did I do on the regular without even thinking about it? If you guessed "poked it repeatedly with the tip of your tongue," then the silver nugget inside your kewpie doll will be twice the size of the original.
Because this kind of thing is so "fun," poking it made me cry out in pain every time I did it. Mind you, I wasn't consciously doing it. It was as though my brain needed constant reminders that I still hadn't healed properly. And what's the most feared of all conditions post-tooth-extraction? If you guessed "dry socket," the silver nugget inside your kewpie doll will be replaced with a small gold nugget.
Of course I looked up "dry socket" on Google, looked at a few pictures, and then hopped to the bathroom to take a look. (I have one foot; I don't run anywhere.) Now... What have I said numerous times on this blog? That's right! I'M STILL NOT A DOCTOR! Let's enlarge that gold nugget inside your kewpie doll for getting that one correct, shall we? My immediate assumption was that I had dry socket. The weird part was that it wasn't nearly as agonizing as advertised. Dry socket is supposed to be INCREDIBLY painful at all times. Mine just hurt when poked.
So I called the dental clinic and said that I thought I had dry socket. I offered to avoid coming in if there was a simple solution that could be prescribed at my pharmacy, but the dental assistant I spoke with said dry socket usually occurs within a few days of the extraction and I was calling in the problem 11 days after the fact. I should definitely come in to be assessed.
Remember when I mentioned my previous "emergency" appointment was set three weeks out? Take a guess at how soon they could see me now. Did you guess "same day"? Double the size of the gold nugget in your kewpie doll if you did! Unfortunately, for me to arrange medical transportation, I need 24 hours, so I scheduled for the next day, which was 15 November 2022.
Meanwhile, I was in touch with my PCP about pain management again. Why my PCP and not the dentist? Because it's best to have ONLY ONE DOCTOR managing your pain medications at all times. If you start getting narcotic pain medications from multiple sources, even if it's for documented, legitimate pain, on paper it will look like you're displaying drug-seeking behavior. That's a red flag to other doctors and pharmacies. And in this age of computers, different pharmacies will know if you've received opioids from another dispenser of such medications.
It makes all of the silly conspiracies about tracking chips in vaccines seem incredibly nonsensical.
The dental visit was short and sweet. The socket was healing just fine, but there was a visible spot of irritation at the tip of my hard palate that indicated I still had lingering infection. Remember that a lot of pus drained from that tooth when it was removed, so residual infection wasn't unexpected. And if you'd forgotten that this post was about infection, I'm afraid I'll have to revoke your kewpie doll.
Without fail, diabetes was part of the wrap-up discussion. "Diabetics are notorious for healing slowly." You might as well get used to hearing that one, since you'll hear it to the end of your days. Cuts, bruises, surgeries... Every medical professional you encounter will assume your recovery will be longer than expected because of diabetes.
So what have we learned, folks?
And now... Boy, do I have a treat for you! Wait, what?! "A kewpie doll"?!? No one actually gives those out as prizes anymore. No, what I have is a prime example of the kind of hairstyles I grew up with in high school! You're going to love it!
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It seemed suitable to give this post the title of one of my favorite songs from Little Shop of Horrors. It's also entirely possible that that very same song is the reason why I fear dentists. Oh, there are plenty of other reasons, but I'm not focused on those. And I'm sure they're out there somewhere, but I personally don't know anyone that's thrilled to go to the dentist, even if all the dentist says, "Looks great. See you in six months."
But those broken teeth of mine needed to be addressed. It was an "emergency" appointment that was set about three weeks from when I called. Nothing quite like a clinic that's overworked and understaffed. And when I initially called, it was the broken tooth to my lower left side that was the issue, causing so much swelling that it could be seen by looking at my cheek! Blessedly, antibiotics cleared that one up.
That's when the broken tooth along the upper front decided to start hurting. And hurting... and hurting... AND HURTING! More antibiotics and MANY more painkillers.
The thing about dental pain is how pervasive it is. It doesn't just hurt at the site of the problem. The pain radiates outward, causing severe pain all over your face and neck. I kept trying not to take 20 mg. of oxycodone every time I started to hurt, even though that would be the final dose in the end. A half-tablet taken every half hour, 5 mg... and 5 mg... and 5 mg... and 5 mg... It was stupid to take it this way. It made tracking when it was safe to take my next dose nearly impossible. Every four hours at the SOONEST! And, stupid me, I'd start the ritual all over again, thinking, This time it'll be different! This time a lower dose will work just fine! Nope.
I saw the dentist on the 3 November 2022. By then I had refined my pain management, taking 10 mg. every half hour and still landing on 20 mg. Because I'm, like, Einstein levels of brilliant. At night, my body was "flirting with a fever." No one would call 99.3 F (37.38 C) a real fever, but it was an indication that something was brewing, especially when my mean temp is lower than 98.6 F/37 C.
So the lovely dental assistant came in, took a couple of x-rays, and -
Okay, when did x-ray machines become hand-held portable cameras? And does this speak to the speed of technology or to how infrequently I've gone to the dentist? What's more, the pictures were INSTANTLY on the laptop on the counter! I was like a Cro-Magnon man pulled into the future and seeing a wheel for the first time!
The doctor came in, looked at the x-rays, and informed me that the two teeth beside the broken tooth on the side were also beyond saving and preparing to shatter. After a quick chat, it was decided to remove four teeth. The shattered one up front and the three on the side.
LET THE NUMBING BEGIN!
I couldn't feel my left jaw, left side of my tongue, and the left corner of my lips. I also couldn't feel my right nostril, upper gums, and right side of my lips. But the infected tooth still hurt. GODS ABOVE AND BELOW, IT HURT!!! It hurt so much that I was sweating, moaning, and instinctively guarding my mouth with my hands! The doctor tried giving me more anesthetic, and while inserting the needle itself didn't hurt, the moment it got close to where the pain resided is when I cried out.
The doctor couldn't understand it... yet.
Deciding to give the lidocaine a little more time to take effect up front, he went after the side teeth. No problems there. All pressure, no pain. He stitched up the site and moved on to the front tooth.
Post tooth removal, he said that a lot of pus came out. The dental assistant added that when the dentist started applying pressure to get a hold of the tooth fragments, pus was being squeezed out of the sides. In other words, that tooth as SUPER infected! It explained why they couldn't numb it. And it continued to drain afterward. I know because the gauze they gave me to press against the site was decorated red and yellow.
Yes, I agree. EWWWWW!
So why bring this up in a blog about diabetes? To demonstrate that we are like walking, talking Petri dishes when it comes to infection. In rapid succession, I was now on my second round of 875 mg. amoxicillin. Despite this, I had an abscess growing beneath the tooth.
We become complacent when it comes to infection. That's because the most common infection is a break in the skin. You feel it, wash it, and maybe put a band-aid on it if it's still bleeding. But if you leave it uncovered... Well, whaddaya know! It gets infected. Some topical antibiotic and band-aids to cover it, and soon you're on the mend.
But what if you can't treat it topically? Like an abscessed tooth. We've come a long way in terms of medicine, so it has become less frequent, but even a dental infection can kill! Look it up if you don't believe me. Just type "dying from abscessed tooth" and marvel at the results. And common breaks in the skin that go untreated can become septic. Septicemia is when your blood is poisoned by bacteria. Or put it this way: your BLOOD becomes infected!
There is so much to worry about. It can be overwhelming. It can even be terrifying. But my goal isn't to turn you into quivering piles of jelly that hide from the world. My goal is to make you more vigilant. We're at a higher risk for infection, so be on the lookout for it. Be vigilant and you should be fine.
Or, you know, do like me and wait until the last minute to have your crumbling teeth looked at. "A lot of pus drained out when that tooth came out," is really the kind of thing you can bring up at parties and family dinners as a topic of conversation... if you don't want to be invited to future engagements.
Let's end on a laugh. There's a little band called Ninja Sex Party, and they have a perfectly 80's-sounding song called Mansion Party. You should give it a listen, if for no other reason than learning that a panda fighting pit is called a "Pandagon."
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NOTE: I chose this song because it's one of the safest NSP songs. No swearing and such. The ones I won't link, but are equally funny to me are: Courtship of the Mermaid (which was my introductory song to them), First Date, I Don't Know What We're Talking About, and Bedtime. Most have "colorful language" that would be unacceptable at work.
It's probably a recurring nightmare for parents... that moment when the kids have learned to count WAY past 10 and start singing One Million Bottles of Beer on the Wall. Especially at the start of LONG a family trip. If you listen hard, you can hear the parents praying, "Please, whatever gods are out there... Kill me, my children, and/or all of us. Just make it stop." The alternative song that brings about prayers for a swift demise is The Song That Never Ends, but it's unrelated to this post.
Time passes, and eventually they/we learn to sing Show Me the Way to Go Home. Oh, but summer camp taught us an even better alternative! Murphy's Saloon, also know as Give a Cheer!
Apparently, the lyrics are regional, but there's nothing quite like a bus full of teens and tweens singing at the top of their lungs about something they know absolutely NOTHING about!
"Hey, Rob...? This is entertaining and all, but does this have anything to do with diabetes?"
The songs? No. The subject of alcohol? Yes.
There are things about the diabetic diet that can drive a dietician to the brink of madness. Two that I can think of immediately. The first is pizza. Between the variable size of slices, to the mystery of how much sugar might have been used when making the sauce, it makes it next to impossible to calculate carb content. The other thing... well, things, plural... are alcoholic beverages.
Drinks for growed-ups contain the perfect combination of substances to make your body scream, "WHAT'S HAPPENING?!?" If your beverage of choice is beer, it's going to have basic carbs. If you prefer mixed drinks, as I do, then they're going to have sugar. Mind you, I now have only one ounce of booze twice a year - once on my birthday and once on New Year's. But there was a time when I wouldn't turn down a well made Long Island Iced Tea. Gods above and below! You can barely make out the taste of alcohol in one made to perfection. I met one bartender whose secret ingredient was powdered lemonade mix. It was a delicious way to get soused. And the sugar in that lemonade mix probably did horrible things to me that the alcohol politely numbed.
Yeah, the sugar/carbs in various adult beverages drive a diabetic's blood sugar upward. If you're out at a bar, you can't exactly ask the bartender to slap a label of the nutritional value of your drink of choice, so you can't really guess at what dose of insulin you should take to cover your night out.
Besides, alcohol lowers the blood sugar.
Yup. The capricious Fates have decided that having a few drinks with your friends raises and lowers your blood sugar simultaneously. Fun, right?
My years of experience have taught me that it's usually the sugar that wins the glucose tug-of-war, but my best advice...? Don't drink. I don't mean "Don't drink EVER!" Save it for special occasions, just as you would a massive slab of seven layer German chocolate cake.
Twice a year, I settle down with a single ounce of Irish Mist on the rocks, and I sip it so slowly that the melted ice usually winds up dominating the glass. I rarely finish drinking it. When I was younger, however, I could knock back my drinks like I was on a mission to kill myself that very night. Peach or peppermint schnapps made me the go-to guy at several parties. "Oh, you wanna get smashed faster? Go ask Rob for some of his stash." There was one night when my friends and I bought a bottle of Mescal simply because Van Halen sang about it in their song Cabo Wabo. I wish digital cameras were a thing back then! "We drink Mescal right from the bottle... A salt-shake, a little lick of lime... Mmmm!" They sang it, we did it, and the faces we made as we swallowed what must surely have been gasoline would have made for some interesting tales later in life.
Here it is, later in life, and I can't help but wonder what kind of damage I did during that relatively short period of partying, my blood glucose bouncing up and down from moment to moment. Mind you, I wasn't an alcoholic. Booze was rarely a part of our regular gatherings... which was good, because I wasn't a happy drunk. Some people get happy or violent. I got depressed. It's why I can't even recall the last time I was drunk.
What my friends and I DID do regularly... is a topic for a different day.
That brings this bit of suggested diabetes management to a close. As with everything else I discuss, what I have to say is a matter of "should" versus "shouldn't." I won't say "you can't" because, as it turns out, I have no way of stopping you from doing anything. And if you doubt what I'm saying or are experiencing outright denial, you can always consult your doctor.
And now, in case any of you are cat lovers...
