Transplant: A reporter and his top story
Living a marginally productive life with all internal organs intact (save, perhaps, for the mind) once was a goal I felt confident of achieving.
Granted, organ retention isn't a goal most people would cite. But organ function does change, as happened with me, forcing an alteration of goals.
In short, I'm sitting here twiddling my thumbs and hoping to qualify for a kidney transplant that, with due diligence, good luck and toothy smile, can sustain me for the remainder of my days.
Not to get maudlin. Actually, I look forward to the challenge -- an adventure I hope to share with readers online with regular updates, insights and color commentary, including my current effort to qualify for a transplant.
But let me backpedal to provide translation about lifestyle transformations and transgressions prompting physical transitions corrected only by transplantation.
David Templeton, Post-Gazette health and science reporter, will blog about his new health challenge, starting Monday.
I've had type 1 diabetes for almost 43 years. Diagnosis came in 1966 the day after Halloween at age 11. I'd lost 10 pounds, making my round head with red hair look like an orange lollipop atop a stick. I never did get to eat that sack of Halloween candy full of beloved Tootsie Rolls and Necco wafers.
Oh, I could tell sob stories of diabetes woe and gnashing of teeth, save for the simple fact my life has been a happy one of playing the cards I was dealt.
Type 1 diabetes occurs when the pancreas no longer produces enough insulin -- the hormone needed to turn sugar into energy. The resulting buildup of glucose in the blood must be controlled with regular injections of insulin.
Keeping blood sugar close to normal becomes the lifelong challenge. Diabetes is a primary cause of leg amputations, renal failure and blindness. It causes heart disease and strokes. It makes colds worse and infections and the flu potentially deadly. Diabetes is a leading cause of impotence and erectile dysfunction.
And there's more good news.
Diabetes makes skin problems itchier. Low immunity and circulation problems can prevent wounds from healing and ruin the gums and teeth. Diabetes turns daily life into a puzzle of balancing insulin and calories. Uncontrolled diabetes can create general malaise and, for many, depression. High blood sugar eventually will kill. Drastically low blood sugar can kill more quickly.
For my first 20 years of diabetes, I had no easy way to test my blood sugar, which explains my kidney disease. A University of Pittsburgh Graduate School of Public Health formula predicts the onset of diabetes complications.
Normal HgA1c -- the measurement of the three-month average blood-glucose level -- ranges from 4 to 6 percent. Most doctors encourage patients with type 1 and type 2 diabetes to maintain an A1c less than 7 and preferably somewhere near 6.
Pitt's formula involves taking the number of percentage points above an A1c of 6 and dividing it into 1,000 to determine how many months, on average, before complications likely will occur.
An average A1c of 8 -- or 2 percentage points above 6 -- would mean 500 months before the onset of complications, or 41.6 years. An average A1c of 10 would pose complications in about 21 years. So someone diagnosed at 10 would suffer complications at 31, or even younger with a higher A1c.
I've maintained an A1c well within the normal range since the late 1980s, when I already had kidney disease. That would suggest that for the first 15 to 20 years with diabetes, when regular blood-glucose monitoring wasn't feasible, I had an average A1c of 10 or higher.
There are no regrets. Actually I provide these details so I can brag unapologetically.
Since 1995, I've maintained an A1c in the range of 4.8 to 5.3 -- well within the normal range. Only once in 14 years has my reading reached 6. Even though I began showing signs of kidney disease in the 1980s, my kidney function has remained fairly steady over 14 years for one simple reason: Blood-sugar levels no longer were destroying what remained of my kidneys.
That along with a fairly healthy diet, regular exercise and almost obsessive regimen of blood-glucose monitoring helped delay the need for dialysis or transplant. Diabetes control became my hobby. I love the numbers and averages and revel in good results while working to improve those that fail to measure up to self-imposed standards.
Unfortunately, many with diabetes ignore their disease, thinking it poses no immediate risk. But problems will surface, often unexpectedly. Then people with diabetes sometimes resign themselves to illness, depression or sense of fatalism rather than alter lifestyle or tighten control. People with diabetes can be stubborn, depressed and full of denial. Just ask my wife, Suellen.
But need I spell out the results of inaction?
In euphemistic terms, uncontrolled diabetes reduces longevity, sometimes by years or decades and in extreme cases by a half century. Diabetes is deadly only if one allows it to be. It can be controlled nowadays with improved testing equipment, modern insulin and medications, and advances in diet and medical care.
My pie-in-the-face moment occurred in 1988 when my eyes hemorrhaged due to advanced retinopathy -- damage to the capillaries in the retina from high blood sugar. I was holding my newborn daughter Georgia when blood filled my left eye like black ink. After laser surgery and growing evidence of kidney disease, I took corrective action.
Now at 54, I attribute my diabetes control to one basic fact: I fear no needle. The idea of insulin injections causes undue fear that prompts some to avoid control. But modern, sharp, disposable syringes cause little or no pain if the injection is given correctly. Fear of needles is no excuse for ill health.
I've given myself 40,000 insulin injections during my 43-year dance with the disease. It's a rare day I don't take at least two injections, with some days requiring three, five or even seven. I've tested my blood sugar -- requiring a jab to the fingertip to draw blood -- about 80,000 times in 20 years. My fingertips are peppered with pinpricks -- battle scars in my war against the disease.
I show them off proudly.
Of course, there are insulin pumps and continuous glucose monitors for those fearing injections and pinpricks. But needles sure beat the pain and trauma of heart disease, strokes, amputations or, as I soon will experience, renal failure.
Actually, tight control also explains why my kidney function did decline, albeit gradually. Once kidney disease starts, it's difficult to prevent progression. I succeeded in doing that for 14 years. But, as it turns out, low blood sugar, or hypoglycemia, also can kill off kidney function, and I've had enough low-sugar episodes, including four trips to the emergency room, that damaged already compromised kidneys.
Balancing low and high blood sugar is a daily tightrope walk.
For now, my kidneys are 16-percent functional, with 15 percent representing a level when people typically must begin dialysis. The average wait for a transplant is two to three years. So maintaining minimal kidney function for the next few years holds deeper meaning. Further declines could mean dialysis.
So I'm doing my best to avoid dialysis by signing up for a transplant while I still have minimal kidney function. It requires a low-potassium and low-phosphorous diet with a weekly dose of active vitamin D to ward off parathyroid problems. I'm hoping to prevent further decline until Transplant Day.
Diabetes has been a roller-coaster ride.
But with a kidney transplant hopefully on the horizon, I haven't changed my life goal:
I, David Templeton, aspire to live a healthy and happy lifespan one blessed needle prick at a time.
First Published October 21, 2009 12:00 am