Diabetes

Question
Posted by: Brian | 2012/04/08

Q.

Diabetic

Hi Doc,
My Brother-in-Law is in the advanced stages oif Diabetes. He gets Dialysis 3 times a week and now also has Heart Failure. He''s 44 but looks 60. He''s had Diabetes for about 10 Years from being seriously obese. Up until now the veins in his arms have collapsed to a point where the Dialysis insertions are now implanted in his Shoulder. A few Months ago he had an Operation to implant new Veins for the Dialysis. He was in ICU for 3 Months - he almost died. At this stage he needs a Kidney transplant but after what happened in the previous op, we don''t think he will survive a transplant - especially now that he has Heart failure. It''s like an Acid slowly coarsing through his veins just eating him up slowly! He is permanently tired and sometimes I can see that he''s all but given up.
I''ve seen people on Dialysis for 10 Years and more. My question is - taking his frail sickly state into account - How long could he possibly keep going like this? His body is giving in very fast. Please be honest and refrain from saving my feelings. I honestly don''t see him making the next 5 Years.
A reply is appreciated.

Expert's Reply

A.

Diabetes expert

Dear Brian
Your brother-in-law certainly is at high cardiovascular risk, based on the information you have given. In the US, 5 year survival rates are about 30%, and ten year survival rates are about 10%, but as usual, these are average survival rates, meaning some will do better and some worse. It does depend on whether he gets a transplant or not. I would suggest speaking to the doctor looking after him to get a clearer picture.

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C.

Posted by: Mariela | 2012/05/31

Chuck Eichten has had type 1 diabetes for over 30 years. He has wrtietn a book called, The Book of Better targeted at anyone with diabetes. The book''s all encompassing message to you: that perfect isn''t possible but improvement always is so why not strive for that?. Talk about hitting the nail on the head.The book is wrtietn in an extremely straight forward style, suitable to those who respond to that and perhaps, most any man. It''s a really witty book, includes fun visual art and a lot of aesthetic appeal (with exception of some white font on yellow background-well at least it''s large white font). This comes as no surprise since Chuck Eichten is Nike''s creative director. In fact, Nike''s timeless Just Do It slogan totally relates to this book, which admittedly delighted me to no end.I have to say, I felt like boxing with the author a couple times. He says insulin pumps are the Best Available Treatment . I agree on the condition that it is actually what works best for someone. And someone isn''t equivalent to everyone. I haven''t had an A1c over 6.0% in over 5 years and I''ve never had a seizure or passed out from a low and I don''t use a pump. I did for seven years and it did not work for me. In Eichten''s opinion, you''re crazy if you have access to a pump but don''t have one. He talks about how pumps allow a person the flexibility to sleep in late, to skip meals or snack in between them, and to be more sexy on dates because it''s probably more of a turn on to be on a first date and hit some buttons on a gadget that''s mysteriously connected to you by tubing than to inject a needle at the table. I use Lantus and Humalog insulin and between the two I can sleep in and skip meals and frankly, I feel sexier when I''m not connected to the pump. It''s just easier to move around and wear dresses and door knobs don''t yank me back by two feet of tubing. And also, Chuck, how do you test your blood sugar? Because the only way I can do it is by bleeding. And I don''t know anyone who finds bleeding sexy. But I know of someone, who find me sexy whether I''m connected to a pump or injecting a shot or pricking my finger. So for me, the human element is the key. Though, many might agree with you and that''s the beauty of it I suppose. It would just be nice to have the other option properly acknowledged because it can and does work for some people.I can''t help but wonder if this hailing of the pump is partly one person''s way of supporting technology to continue advancing for our benefit. If that''s the case, then great and thank you. But I worry about those who can''t get access to a pump, who hear that they are the best thing, and then lose all hope in their MDI. And we all know how important it is that people have hope, right? In all essence it''s like we''re in the same league, playing on different teams, but with the same end goal of winning in mind.Enough about pumps! The book, for me, is an awesome dose of perspective. At least once every chapter I exclaimed, YES! out loud, prompting my husband to ask me what the commotion was all about. The author does a fantastic job of confronting the root issues that people have with certain aspects of life with diabetes and then he explains them in a way that makes a person realize he is right and our excuses are absolutely useless.For example, I have long been in an internal battle over the Yes I can eat that campaign. I feel like yes I can but, I want to be healthy so often, no I can''t You know what I mean? Well, the author reminds us that there are two conditions to the yes I can eat that . We''re empowered patients, after all. People with type 1 can eat anything but if they''re smart, they are going to be picky about when and how much they eat, not because they are strict and deny themselves pleasure, but because they know they deserve to take care of themselves. This is a really powerful message and there are many like this in the book regarding diet and exercise and one''s attitude. By the way, Chuck eats a totally unhealthy breakfast every day and impressively balances it out in real life way you will want to read about.This book does another fine thing by reasoning with our emotions and appealing to our genuine worries. For example he says, You are not boring, you are consistent . People think it''s fun and attractive to be spontaneous and diabetes tries to challenge us on that. And the author is reminding us that the fact of the matter is diabetes likes consistency and if we try to keep some things consistent, we''ll be better off.He also heavily promotes that all people with diabetes move each day. Instead of sounding like a doctor you''ll be healthier, your risk for heart disease will be lower , the author actually goes to the true places in all of us and mentions how, for example, if we move more, we''ll spark a chain of events that will ultimately

Reply to Mariela
Posted by: Diabetes Expert | 2012/04/16

Dear Brian
Your brother-in-law certainly is at high cardiovascular risk, based on the information you have given. In the US, 5 year survival rates are about 30%, and ten year survival rates are about 10%, but as usual, these are average survival rates, meaning some will do better and some worse. It does depend on whether he gets a transplant or not. I would suggest speaking to the doctor looking after him to get a clearer picture.

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