For Want of a Cup of Coffee

I know what you're thinking. "Rob, you absolute paragon of diabetes control. You're like a divine presence come down from the Heavens to lift us up with your stylistic ramblings and fill our heads with important information about diabetes." Yup. Guaranteed, that's what you're thinking, word-for-word. 😉

Okay, so I'm not exactly a psychic. But I have the distinct feeling that some of the people reading this blog might think that I think I'm the patron saint of diabetics. 

Not even close. I'm a good diabetic most of the time. But some of my choices fall under the category of "Do as I say, not as I do."

My last post was about my diagnosis of cardiovascular disease. If you don't know, such a diagnosis comes with even more dietary changes. Reduced fat. Reduced salt. No caffeine. They might as well have told me I'm only permitted to drink water and eat nothing but cardboard. What's funny is that these restrictions are already built into a diabetic diet in hospitals. I found that out when I had to stay the night after the angiogram. They sent me a meal that was labeled "heart healthy," but with packets of sugar and a fruit cup loaded with fructose. So I called down to let them know that my meals should also be for a diabetic, and that's when I was told the diabetic menu was even more restrictive than the heart healthy one.

Reduced fat, reduced salt, no caffeine, and NO SUGAR! 

Now it's the water and cardboard diet, for sure.

During a follow-up appointment with my cardiologist, I credited him with bringing my blood sugars under tighter control. He initially rejected this idea until I explained that with my cardiovascular system no longer struggling as hard to function, the overall stress on my body has been reduced. Similar to the "fight or flight" reflex, my body was in near-perpetual "fight mode" just to function before the stent was placed. That meant naturally occurring steroids were constantly being released into my bloodstream, and steroids make a diabetic's glucose level go up, UP, UP! So once I'd shared my hypothesis with him, he agreed that he might very well be responsible for my blood sugars improving.

Mind you, it was a marginal improvement, but an improvement nonetheless.

For the record, I tried. I did. I bought decaffeinated coffee to get my day started. I'm not affected by caffeine for some bizarre reason. In terms of alertness, that is. If anything, I typically experience caffeine crashes after drinking a cup of coffee. After years of drinking regular coffee, decaf tasted... off. Only one brand ever got it right, and I can't find it for the life of me anymore. 

~ shakes fist impotently at the sky ~ Damn you, Maxwell House!

So I, ummm... I gave up. I have my ONE cup of java in the morning, and that's it. Just one. And one, is seems, is about all I can handle at this point. Because when I drink my singular cup of joe, things inside my aging body go absolutely goofy. 

Let me be clear. The only carbohydrates in my coffee come from my sugar free, French vanilla creamer. Somewhere between 8 to 10 grams of carbs total, which on a diabetic exchange diet isn't even the equivalent of one piece of bread. (15 grams = one bread.) The artificial sweetener I use adds zero carbs. 

I believe I've discussed it before, but I'll review how I decide how much insulin to take. I check to see what my glucose IS, calculate how many "breads" I'll be having with the coming meal, and then add enough for what I assume my glucose WILL BE. Because I'm insulin resistant, my doses are high. VERY high. In fact, when I tell hospital staff how much insulin I would normally take, they silently assume I'm trying to get them to kill me and go with their preset standards. They come in and tell me they're going to give me a "very high dose of 11 units," and I'll reply, "Oh, that is adorable." Later, when my blood sugar is checked and it comes back at 400 or more, they start taking me seriously. If my blood sugar is normal, between 80 and 110, I'll take 28 units of Humalog if there are three "breads" in my coming meal.

But in the morning, if my glucose is normal, (which is rare*), and I'm going to have my coffee, and ONLY my coffee - no other food of any kind - I take... Brace yourselves... 

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48 UNITS OF HUMALOG!

That's probably enough to kill a bear, if not an elephant. This is because the coffee puts a lot of stress on my cardiovascular system. Has this been confirmed medically? Nope. But I'm not eating anything else in the morning, my creamer is sugar free, (but still has carbs, which are accounted for), and I use artificial sweetener. So if someone else can come up with a better theory, I'm all ears. The closest thing to "proof" are my sparkling lunch readings, which DO come closer to that perfect range.

*About my fasting blood sugars rarely being normal... This is a whole different issue about balancing my insulin doses more carefully at night, which I'll try to get into in the near future.

I'm 55. I have no family. My friends are all distant. I'm both alone and lonely. So I'm going to break some of the rules every now and again, especially if breaking them means I get a little enjoyment out of life.

The proper summoning configuration

to get me out of bed in the morning.

Heart Broken

Yeah, yeah. "Heartbroken" is one word. Since I make an effort to choose my words with care, (although you'd never know it with some of my typos), I'm not writing about a failed relationship. In fact, I'm not really talking about my heart in this post, but my vascular system. Still, it's a cardiologist who oversees my "heart" disease, making the post's title appropriate. So nyah! 😛

It was probably about 10 years or so ago when I was prescribed my first bottle of nitroglycerin, (commonly called "nitro" to save on syllables). Yes, I'm one of millions of people walking around - "hopping around" in my case - with what is supposed to be an unstable explosive compound in my pocket. Well, kinda. Through some kind of pharmacological voodoo, the compound is rendered harmless in terms of explosions and such.

The reason it was given to me was because I was experiencing an occasional tightening sensation in my chest. Nitro is a vasodilator. If you've ever had your pupils dilated, then think of nitro doing that, but to blood. However, my symptoms were so infrequent that my past PCPs never thought it important enough to recommend I see a cardiologist.

And then the frequency started to increase.

There were other factors besides symptoms that pushed me to see a specialist. First and foremost is my family's history with cardiovascular disease. My paternal grandfather died from a sudden heart attack at 65. (Might have been age 60, but that's because one memory collided with another and the math did strange things inside my head.) My father was in his 60's when he had to have a triple bypass and mitral valve replacement. My brother, two years younger than me, tore his ascending aorta while he was... ummm... Well, he and his wife were alone, and... uhhh... Y'know, doing married couple stuff. As I understand it, his condition should have been fatal. By some miracle, he lived. So, yeah. The men in my family didn't have a good history when it came to cardiovascular health.

Another reason was that I was 50 when I asked my PCP to refer me to a heart doctor. The big 5-0 is when you should really start paying more attention to the possibility of a number of illnesses, including heart disease. Doctors can perform basic tests to monitor for such conditions.

Finally, just in case you didn't already think of it, I wanted a heart doc because I'm a diabetic. A lack of glucose control can force the restructuring of existing blood vessels, so heart disease is almost inevitable for diabetics. Almost. 

The thing that my brain latched on to was that doctors and nurses kept referring to the tightening sensation in my chest as "pain." Silly me, I would try to correct them that pain hurts, and this didn't hurt. It just felt uncomfortable and worrying. Eventually I recalled heart attack victims describing that it felt like an elephant was sitting on their chest, so... Yeah, I guess it really was a kind of pain.

My newly acquired cardiologist ordered some tests, including a stress test. This is where they usually force the patient to be active briefly, and then record how the cardiovascular system handles it. I, however, had to be the difficult patient, what with me dealing with the giant hole in my foot. The stress on my heart had to be chemically induced, and... it did not feel good. It was unnatural to be sitting still, engaging in next to nothing except conversation with the technician doing the test, when suddenly my whole body was flushed with blood, my heart pounding away. 

The result of the tests indicated that heart disease was indeed settling in, but my doctor believed it could be managed with medications. He put me on a cocktail of four different medications and scheduled a follow-up appointment.

On my next visit, I still wasn't feeling quite right, so he increased one of the medications.

Rinse and repeat for the next visit, with the same medication increased.

At that point, I felt okay. Reaching for a nitro tablet became a rare occurrence.

Then COVID-19 decided to enter all of our lives. I had the pandemic trifecta of pre-existing illnesses that would make for miserable circumstances if I should catch it. Diabetes, overweight, and cardiovascular disease. By some miracle, I didn't catch it. But the stress of its very existence started doing that thing to my chest again. So when I called the cardiologist to let him know what was going on, he deemed it time for us to do an angiogram so he could see what was going on inside me with his own eyes.

I knew the basics. He'd go in through an artery and have a look around. What I did NOT know was that his exploration would be broadcast onto a huge TV screen right there in the catheter lab and that I'd be pumped full of blood thinners. They gave me a bit of sedation so mild that I didn't really feel its effect at all.

Here's what we learned. Keep in mind that he didn't name the arteries, only calling them "the first, second, and third." 

The first was in good shape. Not GREAT shape, just good shape. 

The second required the placement of a stent. This involved him sending in a balloon surrounded by a metal mesh and positioning it where a blockage was forming. He inflated the balloon, widening the artery and supporting that widening with the mesh. How the stent stays in place is something of a mystery to me, but it stops that artery from narrowing again. This part of the procedure meant I'd be on blood thinners for the next year while new arterial tissue grew over the stent.

The third artery... Ohhh, that third artery. Totally, completely, 100% blocked. He even had me look at the screen so I could see him bumping the wire probe uselessly against the blockage. But while that blockage was forming, my body took the initiative and tried to effect its own repairs. I have collateral arterial growth that bypasses the blockage. However, this isn't the good news it sounds like. Do you remember, even vaguely, when I talked about neovascularization in my diabetic retinopathy post? Like the new blood vessels in the eye, the new arteries aren't as good as the original equipment. In fact, when the doc was starting to explain the collateral arterial growth, I asked, "Like neovascularization in diabetic retinopathy?" To which he replied, "Exactly."

This procedure should have been an in-and-out experience, but I just had to be the troublesome patient. My blood refused to clot, so I kept bleeding from the hole in my wrist where he'd entered my vascular system. I was kept overnight, with nurses checking on my leaky wrist every two hours.

If you're ever hospitalized, remember that you're not there to rest; you're there to get well. And if that means a nurse interrupting your sleep every two hours, so be it.

So that's my tale of how I was officially diagnosed with diabetic heart disease. What makes this different from regular heart disease? I'm a diabetic. That's it. It's probably not REALLY diabetic heart disease, but the fact that I'm a diabetic means the word "diabetic" is likely to be thrown in front of every diagnosis I receive.

Before I go, this...

You didn't think I'd be serious,

at the end, did you?