Ruminations

Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Thursday, January 20, 2011

Diabetes "Myths"

People afflicted with diabetes walk a tightrope of blood sugar control. Both high- and low-blood sugars on a consistent and repetitive basis represent threats to longevity and overall quality of health. Long-term diabetes often leads to neuropathic problems (which may result in limb amputations), eyesight impediments (leading to blindness), heart attacks, stroke potential and kidney failure.

The struggle to maintain consistent, balanced, moderate blood sugar levels is uppermost in physicians' minds and that of their patients.

Both high- and low-blood sugar counts are threatening episodes to be avoided if at all possible. Extreme and ongoing hyperglycemia (high-blood sugar) will inevitably lead to vital organ destruction. Extreme hypoglycemia can lead to convulsions as the brain becomes starved of fuel - can sometimes lead to death. The balancing act of maintaining acceptable control is a difficult one.

Adult-onset diabetes, commonly called Type II, is considered a lifestyle disease; obesity combined with a sedentary habit, treated with drugs. Whereas Juvenile-onset diabetes (infants, children, teens, young adults), now called Type I, treated with multiple daily insulin injections, has its genesis in the mystery of the auto-immune system going berserk resulting in the Islands of Langerhans in the pancreas no longer able to produce insulin.

Type I diabetes is extremely difficult to manage, even for the most conscientious and accepting of patients, requiring extreme self-dedication to the task at hand. Many people resolve to rise above this chronic threat to normalcy, treating their condition as an inconvenience and adeptly rising to the challenge to live a life as close to normal as possible, while managing to take the care required to enable them to do so.

Others are more vulnerable to feelings of inadequacy and resentment, both reactions that in the long term become extremely self-fulfilling and often leading to the early onset of life-continuing complications. Some young people with diabetes defy and in a sense deny the limitations imposed upon them by their revealed condition which makes them vulnerable to self-destructive impulses leading to impairment and death.

It is difficult to feel much in the way of outraged sympathy for a young woman employed by the Canadian International Development Agency who insists she has the right under Canada's guaranteed freedoms to embark on year-long assignments to potentially dangerous geographical hot-spots. Bronwyn Cruden had already travelled through her field postings to countries like Togo, Jordan and Egypt.

She considers herself ill done by because of a Health Canada policy that does not permit federal employees with Type I diabetes to be posted under government auspices to hostile environments. "It would put the lives of other people at risk", is the explanation put forward by Justice Department lawyer Alex Kaufman, representing CIDA and Health Canada at a Canadian Human Rights Tribunal.

"Afghanistan", he explained to the discrimination enquiry where Ms. Cruden lodged her complaint, "is dangerous enough as it is; we do everything we can to minimize the risk." Reasonable and responsible. People with Type I diabetes in particular are essentially far more vulnerable to health problems than those whose bodily functions are not impaired, dependent on injected life-prolonging and -normalizing endocrine hormones.

Ms. Cruden is concerned about her career. She informed the tribunal that the long-term (year-long) posting denied her to Afghanistan because of her diabetes would have given her the kind of field and management experience she considers to be critical to advancement within CIDA. She is now demanding compensation for lost wages and opportunities. And insists that Health Canada should change its policy.

Anyone who has witnessed a Type I diabetic go into convulsions as a result of extremely low blood sugar will never forget it. It is a horrifying and spectator-helpless spectacle of the body in extreme duress. Ms. Cruden testified before the tribunal that she monitors her blood-sugar levels very carefully. While on a previous one-month assignment to Kandahar she had erroneously taken an insulin overdose.

That resulted in a severe low-blood-sugar episode where she began violently convulsing in her bed. A startled co-worker in the next room heard the commotion, alerted medical staff, and Ms. Cruden was rushed to a nearby hospital where she was treated, then discharged. This was an incident witnessed by others, there well may have been other such incidents Ms. Cruden prefers not to divulge.

There are many people who live with diabetes and who accept that they must, for safety reasons - their own and that of other people - live within certain boundaries. That awareness of personal responsibility both self-directed and outwardly, has caused some not to acquire driver's licenses. There are times and there are reasons why individuals must accept limitations imposed upon their aspirations.

This is one of those times for this particular ambitious young woman. Who may find the satisfaction she craves through other avenues less potentially fraught with danger to herself and to those around her.

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