I am a family physician and I have type 2 diabetes. Type 2 diabetes is where you initially have enough insulin produced by your body but are resistant to the insulin, i.e.: you don’t have enough receptors for the insulin to plug into to act on the sugar/carbohydrates you ingest. As time goes on if you don’t manage your diabetes your body will stop producing insulin and you will need to be on insulin shots for the rest of your life. Type 1 diabetes is where you don’t produce any or very limited insulin and have to be on insulin for your lifetime. Type 1 is found almost exclusively in children.
Type 2 is primarily in adults, but it can be found in all ages. Some symptoms of concern that should raise the suspicion of diabetes include constant hunger, extreme thirst, unexplained weight loss, sores or scratches on the skin that either fail to heal or take a prolonged healing time, excessive urination, dry mouth, itchy skin, blurred vision and repeated or difficult to treat yeast infections (either in men or women), difficulty with coordination or train of thought. Having any or a number of these symptoms does not absolutely mean you have diabetes, but it is concerning enough that you should seek testing with your physician to determine whether you have it or not.
Remember: The earlier diabetes is found the easier it can be to treat and the risk for damage to your body is decreased. You can expect your physician to perform some common tests, such as a random blood sugar, fasting blood sugar, a HgbA1c, a urine analysis and possibly a glucose tolerance test. If the testing reveals that you have diabetes your physician will likely start you on oral medications and possibly insulin and refer you to a diabetic educator. Your physician will also arrange for close follow up and repeated lab work to ensure that the treatment course is working and that no additional measures are necessary to control your diabetes.
I found out exactly one month after 9/11 that I had developed diabetes despite history of it in my family. I did have some risk factors that included a sedentary lifestyle (I had episodic exercise but nothing regular), overweight by 20-25 pounds, stressful work schedule and irregular sleep patterns also due to work. My blood sugar was high enough that in addition to being placed on Actos, an oral agent that maximizes the receptors where the insulin your body produces can act on the sugar you eat, I was also placed on regular short acting insulin before meals along with Lantus (a long acting insulin) once per day in the evening. I was determined to gain control of my blood sugar and get off of insulin.
“Getting control” is medical language for keeping your blood sugar between 80-110 mg/dl (normal range for non-diabetics and optimal range we diabetics aspire to). This is accomplished by controlling your intake of carbohydrates/sugar, exercise to open receptors in your muscles to help metabolize the carbohydrates/sugars you ingest, maintaining or losing weight, cutting back on stress, checking your blood sugar both before and after meals and managing your medications with the help of your physician.
One of the motivating factors is that in a post-SHTF world the availability of insulin in any form will be minimal to non-existent (not to mention that insulin has a rather short shelf life and must be refrigerated). If you have type 2 diabetes that requires insulin (certainly type1) and it is not available you will have a life span that will be significantly shortened.
First, we will address how you control the intake of carbohydrates/sugar. This is not just cutting back on candy/cakes and sweets. Carbohydrates and sugar are found in so much of the food we eat. Simple sugars can be restricted more easily than complex carbohydrates. The totality of this topic exceeds the scope of this article. You will need the guidance of your physician and dietician/diabetic educator for exact recommendations as to your mealtime and snack restrictions. In my case, I keep my total grams of carbohydrates at 45-60 for each meal and 15-20 for any snacks I consume. Of course, there are the occasions where I exceed these restrictions but that is very rare. Just remember that complex carbohydrates are necessary but cannot be consumed cart blanche.
Next is regular exercise. This has to be an aerobic exercise where your target heart rate while exercising (220 minus your age) is multiplied by 60-70%. This heart rate is maintained at a minimum of 30 minutes 4-5 times per week. Make sure you have your doctor’s approval to start an exercise program and remember you have to gradually build tolerance to the program as going from being sedentary to tolerating that level of exercise takes time. A fast walk will work just as well as jogging but with a great deal less stress on the joints, muscles and tissues. And remember the more you stress on your body the greater the chance of down time due to injury and the resultant loss of conditioning.
Other good aerobic exercises include swimming, rowing, cross country skiing, hiking on uneven terrain, jumping rope, bicycling and calisthenics. Remember to start slowly and gradually increase the intensity as well as the length of time you exercise. Make sure you know your resting pulse before you exercise and what your target heart rate is supposed to be while you exercise and monitor your pulse while you are exercising. Optimal conditioning occurs when your post exercise heart rate returns to your resting heart rate within 5-10 minutes after you finish exercising. If your heart rate while exercising is below your target increase your workout intensity. Conversely, if the heart rate exceeds your target cut back on the intensity. Keep in mind this is your new lifestyle and not a race.
Serious About Weight Loss
Next is weight loss or maintaining weight. Losing weight is merely using more calories (such as though exercise or activity level) than you ingest. Remember it takes a deficit of 3,500 calories to lose one pound (and an excess of 3,500 calories to gain a pound). The dietician is a great resource to help you define your ideal body weight and to help you reach your weight goals.
A good rule of thumb for ideal weight in women is 100 pounds for the first five feet of height and five pounds for every inch beyond that. For men it’s 106 pounds for the first five feet and six pounds for every inch beyond that. So, for a six foot tall man, 106+(12×6) =178 pounds. That is based on a medium frame size. This is usually determined by reaching around your wrist with the opposite hands middle finger and thumb. If the thumb and middle finger just touch that is a medium frame. If they overlap by an inch or so that is a small frame and a 10% reduction is taken from the height based weight calculation. If the thumb and middle finger fail to touch by approximately an inch a 10% addition is added to the height based weight calculation. As you exercise, following the dieticians recommendations for diet and weight loss (and certainly weight maintenance) will be achievable.
Another goal is to cut back on stress. If you have a stressful job or lifestyle you need to ask yourself if your health is worth that promotion or if that new phone/car/house/keeping up with the Jones’s is really worth losing your vision or toes or possibly having a heart attack or stroke. All are potential consequences of poorly controlled diabetes. Taking a step back and deciding what really is important to you and your family will not only lengthen your life but can also make your life more fulfilling.
Goodbye to Insulin
It was exactly four months after I found out I had diabetes until I was able to get off of insulin. I was able to manage my blood sugar quite effectively with a single pill daily as well as activity/exercise and closely following a diabetic diet. Unfortunately, I have also developed Crohns Disease (an inflammatory disease of the bowel that can cause severe episodes of bloody, explosive diarrhea) that when flaring needs to be treated with prednisone. This treatment can cause an unintended consequence in that it can spike your blood sugar. In my case my blood sugar spiked to well over 450 causing me too slip into delirium and ended in a coma, ambulance ride and time in the ICU.
Through the use of insulin, as well as other treatments and countless prayers by my family and friends, and the skilled hands of numerous doctors and nurses, I was able to go home. In the interim three and a half months, I have almost gotten off the prednisone and my Crohn’s is in remission and I have weaned off a little more than half of the regular and Lantus insulin with the intent of eventually getting off the insulin completely. I recall reading a novel titled One Second After. In it, a teenager with type 1 diabetes died a slow death due to the gradual loss of availability and efficacy of insulin in a post EMP world. I sincerely wish to avoid this fate. I fight the battle daily to control my diabetes. I plan for the impending SHTF, prepare with the recommendations and insights afforded by this blog site, and also stockpile my oral medications so that I can use my medical expertise to care for my family and friends when TEOTWAWKI occurs.
Stockpiling Oral Meds
Stockpiling oral medications can be achieved in a number of ways. First, let your physician know you are concerned with having access to your meds should the supply chain be disrupted. Some of your medications can be ordered in twice the strength than you are taking and broken in half. This simple method will effectively double your supply. Another method, if your physician is willing, is to have your meds ordered through your usual pharmacy supplier (such as express scripts) and also have your physician write for the same medication in generic that you can take to Wal-Mart and buy with cash (not using your medication coverage as they will not let you double up the same medication for the same time frame). Another is through mail order from reputable pharmacies in Canada or Mexico–again if your physician is willing to write extra scripts.
And finally, you can go into Mexico and buy your scripts without having to ask physician to write double scripts. Keep in mind you can only do this with non-narcotic medications. Once you have the extra medications leave them in their bottles and add a desiccant and oxygen absorption packets and then place them in a vacuum pack bag and put in your freezer. This method should allow the medication to last for years as you will be protecting it from the two greatest enemies to medicine; heat and oxidation. Make sure you rotate the older medication with the newly acquired. The methods listed in this section can be used for any medication you are on with the exception of narcotics and controlled medications.
Finally, I would like to recommend some great reference sites: AAFP.org (American Academy of Family Practice), WebMD.com, mayoclinic.org, clevelandclinic.org, hopkinsmedicine.org, and NIH.gov (National Institutes of Health).