Wednesday, March 30, 2011

Welcome . . . to the Twilight Zone!

Sometimes, I truly feel like I am living in some weird, messed up dream.  I got home from work today a little after 5:00, and although hubby's vehicle was in the driveway, the front door was locked.  My first thought: he never got up today.  Wouldn't be the first time.  Yup, he was sound asleep, and the dog was desperate to get out, as she hadn't been out for 12 straight hours.

After I ate dinner (again, by myself), I realized his box of pills was still in the living room, untouched for the whole day.  Mind you, he has pills to take at 4 different times throughout the day, and they are supposed to be taken on time.  I took them into the bedroom, then woke him up and made sure he took them (yes, this is one of those things that really pisses me off!).  When I questioned why he was still in bed, he "explained" that he got up at some point today, then fell and hit his head.  So he went back to bed.  When I asked him if his head hurt, had a bump on it, or if he had a concussion, he told me no, but couldn't really explain why he felt it necessary to sleep the whole day away.  He then went back to sleep and slept for a couple more hours.  He is just getting up now as I am winding down for bed, and of course the TV went on the moment he got to the living room.  Most likely, he will be parked in front of it all night, while I run the fan in my room so I can sleep and not have to hear the TV.

My thought right now is that I have gotten so used to this, I just go with it when it happens.  I enjoy the quiet when he is in bed, but also get really angry that he hasn't even bothered to let out the dog or take his pills.  I gave up fighting his ever-worsening, crazy non-schedule years ago.  It definitely got much worse after the kidney transplant.  Is it the meds, his depression, being on disability and having no deadlines anymore, or has he just given up?  I have no idea, and his doctors have given few if any answers to this. 

What I do know is that I rarely plan outings that include him anymore, as it often doesn't pan out with either his wacky non-schedule or the way he feels on any given day.  It is just so much easier to do whatever it is on my own.  Yes, it makes me sad to admit that, but I still have things I want to do, and places I want to see.  Sadly, I usually do these things without him now . . .

Sunday, March 27, 2011

Thanks and Welcome to some "new" bloggers!

We have been hearing from some other bloggers recently, at least one (S/newtothis) who just began her own blog.  I have added them all to the list of blogs I follow:

S/newtothis: Day to Day with a Diabetic

Michael Hoskins: The Diabetic's Corner Booth

Sandy: A Diabetic Spouse

I have enjoyed your humor, especially when you said maybe I should "slap him upside the head" anyway, as he probably wouldn't remember later, anyway.  Glad to have you join us, and no, we are not polygamous . . . also pretty funny, but understand why that might be misinterpreted at first!

Thank you for having the courage to comment on my site, and I hope you continue to share your insights as a Type 1 Diabetic. 

Although frustrated at times, you also manage to still be positive . . . which I probably also need to be whenever possible.

Thank you all,


Saturday, March 26, 2011

First comment from a Type 1 Diabetic

Michael Hoskins said...Lilly: Thank for you for your blog, and having the courage to share such personal aspects of your life with diabetes (as a wonderful Type 3 spouse!). On one hand, it's very informative and I appreciate hearing your views... However, it does scare the crap out of me. I've been reading many of the D-Wife blogs and have traditionally found them to be focused on pre-D or T2 and much different than what I've been living with as a Type 1 of 27 years married for about five years. Yours is the first I've found, and it seems like a look into what could be down our road. That's what scares me, knowing what could be possible. I don't see the same "yelling match" type issues that so many describe, but it has happened and we acknowledge it can be an issue. I always feel horrible (and do remember) and wish it wasn't the case... Anyhow, thank you for doing what you do. I'll look forward to reading more!


Thank you for reading my blog, and I really am sorry I've scared the crap out of you!  As the spouse of a Type 1 diabetic, I feel scared as well, and that sometimes comes out as anger.  It is never easy, and I can often only imagine how it must feel for my husband at times.  Your comments are always welcome, and thank you for not being negative.  I honestly thought that if I ever heard from a diabetic spouse, he or she would be very pissed off, as I am (most of the time) painfully honest on this blog.

My husband has been a Type 1 for over 30 years, and when he was first diagnosed, he probably did not get the care and expertise that he should have had.  I can only guess at how much that affected his health later on.  I did go to your blog and read a few entries, and it sounds as if you are trying very hard to maintain yourself at optimum blood glucose levels.  I will be "dropping in" again to see how you are doing, and maybe it will help me to understand what is going on with my husband a little more, at least with controlling his sugars, as it seems you struggle with that, too.

Thank you,


Wednesday, March 23, 2011

Your kidney is my kidney: or is it the other way around?

newtothis said...
Hello Lily, I found DW a few weeks ago and have been reading the blogs she links to her site. I read your blog as well as your comments on her site. This is a comment to your comment on her blog. You had mentioned that you now correct your husband in public on his denial(s). What I found humorous was your mentioning the medication he takes so he does not reject "his" kidney. Sorry but I did laugh. I laughed because "his" kidney is "your" kidney. Right? You don't know me and I'll admit I've had a hard weekend dealing with my P-DH's mood swings. As a mother I know we GIVE birth and once given it's their's. But a kidney? Surely one who gives an organ should receive continued credit from the receiver. Especially if the person getting the organ is the spouse. Hopefully I am not too out of line for addressing this to you. If your DH can be as mean as mine the last thing I wish to bring into you life is conflict. I admire the selfless gift you gave to another. You are amazing, the only way someone is getting one of my kidneys is over my dead body. (I say this tongue-in-cheek, I'm a registered organ donor.) Thank you for your blog. S


Glad you have found my blog, and thank you for the comments.  Always nice to get a new reader!

Yes, you are right, and I understand the humor.  I think we all have learned to laugh at off-the-wall things!  "His" kidney is (or at least was) "my" kidney.  And yes, there are times I want to literally slap him upside the head and tell him he needs to take better care of himself and the kidney I gave him.

However, when I made the decision to donate, I also made the decision that once transplanted, it was his kidney.   Are there some days I wonder if I would really do it all over again?  You betcha, and on those days, I don't feel so amazing . . . but thank you for saying so!

Unfortunately, my husband underwent some mental/psychiatric changes after the transplant that I was not at all prepared for.  Some of the anti-rejection meds he will have to take for the rest of his life make his blood sugars run high, and others seem to have taken their toll on his (and my!) mental well-being as well.  The anti-anxiety meds he is taking now are probably counteracting another med he has to be on.  It is really a vicious cycle, and I wish more people fully realized that an organ transplant is never fully "over." 

Response to comments on articles

I wanted to respond to some of the comments on the past 2 articles I have posted.  Some of you have been grateful for the information, others have been ambivalent, and (thank God!) at least some of you feel it doesn't really apply to your hubby.  By the way, thank you for all the input. 

To the article on brain lesions, etc.:

Diabeteswife said...
"I have long said that if neuropathy is causing nerves to die off, blood veins to constrict.....why wouldn't it also be causing constriction to nerves/blood vessels in the brain? Only makes sense to me.
If feeling and sensitivity are gone in the feet....why not other areas of the body including the brain? Maybe it starts first in the lower extremities, but I do believe it makes it's way through the entire body.
Sure wish some doctor would agree with me!"
I agree with you: I believe neuropathy eventually involves all areas of the body.  Apparently, some doctors at least suspect what you are saying, according to the article I posted, but it doesn't seem to be something that's talked about.  I do have a friend who lost her husband a couple years ago to Type 2 diabetic complications.  Along with kidney failure, etc., he also had a severe case of vascular dementia, which his doctors felt was diabetes related.  Perhaps not directly related to nerve damage, but when she finally "got" someone to do an MRI of his brain, the vascular damage could actually be seen.  His neurologist ended up apologizing to her, as her hubby kept passing all the tests for memory, yet she KNEW something was wrong.  The MRI finally proved it beyond a shadow of a doubt.  For her and hubby, although he could not be "cured" of the progressive dementia, it helped them to know what was really happening to him. In response to the article on Type 2 diabetes and disability:
tomswife said...
"OK, honestly, I didn't read the entire article. Its too much for me. my thoughts? our young people are too sedentary and its horrible how many have or are getting diabetes but really, are we supposed to be living longer than 70, 80, 100 years old? I hate this... if someone in their 70s gets sick well, I don't want to lose my family members but do I want to go through that? its so confusing I hate reading stuff like this...."

Toms Wife,
I am also alarmed that so many young people are ending up with this disease.  I know a few of them, and it is heart-breaking to know what may lie ahead for them.  My goal in posting the article was because so much of it sounds like things many of our husbands are going through.  Yes, it is upsetting, but for me (and I hope others) it is helpful to know that some of this is to be suspected.  Still doesn't make it easy by a long shot, but I am one who wants all the information I can get: alarming or not.  Remember, I'm the "crazy woman" who gave her husband a kidney.  By the same token, the last thing I want to do is alienate one of my "sisters" by upsetting her.   Sorry if that is what I did.  Please understand that was not my intention.

Lynn Barry said...
"Excellent hubby is a textbook case it must be according to this article...thanks so much for posting it. he had a mini stroke, it effected his speech, he had a stent put in hi heart, he is on depression meds.. high blood pressure meds., hugh cholesterol meds, and all the diabetes meds, neuropathy meds. insulin, and yesterday he lost his balance and so is all expected it appears in some people and he is one of those textbook cases...he is 100% because hs was exposed to agent orange while serving in Viet Nam...he was a very active kid growing not so much. THANKS, LILLY XOXOXOXOOX"

I am happy you were able to benefit by the article.  I thought it spoke to many of us!

Crazy Wife said...
"WOW! Thanks for posting this. Although I think most of "us" already know what this disease can do. Perhaps we should conduct our own study. Do you think the Doctors even consider the effects on the spouse? I would love to find that article!!"

Crazy Wife,
I am still waiting for that study . . . on the spouses, that is!  The only thing I have seen is the really high divorce rate, which I guess doesn't surprise any of us.  If I find anything, I will be sure to post it.  Or maybe you are right: maybe we really should conduct our own study.

Wednesday, March 16, 2011

Type 2 Diabetes and Disability

 For those of us who have wondered about changes in our diabetic hubbies, here is another very interesting article, also courtesy of the University of Buffalo website. The research was done in Australia. It validates what many of us have been seeing at home. Sadly, I believe my husband has every complication mentioned, even though he is a Type 1 diabetic. Although concerning, it is well worth reading to the end, as there is much information here.

 Type 2 diabetes mellitus and disability


David G Bruce, MD
University of Western Australia
School of Medicine & Pharmacology, Fremantle Hospital
PO Box 480, Fremantle, WA 6959, Australia
Diabetes mellitus is one of the commonest chronic diseases and was estimated to affect 4% of the world's population in 1995. The prevalence is increasing and could reach 5.4% by 2025 (King et al., 1998). Type 2 diabetes accounts for more than 90% of cases and is often considered a condition of affluence because of its strong association with obesity and physical inactivity. Yet the majority of affected people (more than 70%) live in low or middle income countries. In low income countries type 2 diabetes tends to be most prevalent in the wealthiest parts of the population whereas in high income countries the poor are most commonly affected. These social gradients only tell part of the story however and diabetes is increasingly seen in the urban poor in all countries.
The underlying causes of type 2 diabetes are similar worldwide. Access to relatively cheap energy-rich diets coupled with obesogenic environments lead to low physical activity levels and result in metabolic changes that predispose to obesity and diabetes. The genetic basis of type 2 diabetes is mostly polygenic in origin and a family history of diabetes confers a substantially increased lifetime risk of developing the condition. This increased heritability may be due to either familial behavioural effects or through genetic and epigenetic mechanisms but it suggests the alarming possibility that a positive feedback loop could increase the susceptibility to diabetes of future generations (Fetita et al., 2006).
In predisposed individuals, various body tissues and organs become resistant to the effects of circulating insulin levels and this insulin resistance causes a range of metabolic abnormalities. Diabetes develops in insulin resistant individuals when pancreatic insulin secretion fails to compensate adequately leading to an inability to maintain normal blood glucose levels (Stumvoll et al., 2005). Hyperglycemia, i.e. chronically elevated blood glucose levels, defines diabetes and is also the cause of many of the adverse consequences that result from the disease. Established type 2 diabetes is generally irreversible and is usually progressive because pancreatic beta cells continue to lose their ability to manufacture and secrete insulin. Consequently a progressive increase in the intensity of medical therapies is required and many patients need to take multiple medications including insulin injections to control blood glucose levels. The pathological consequences of prolonged hyperglycemia include disease of the small arteries that supply the retina, kidney and the peripheral nervous system and this leads to the 'typical' complications of diabetes: retinopathy, nephropathy and peripheral neuropathy.
Many patients with type 2 diabetes also have hypertension and hyperlipidemia. This clustering of conditions, often termed the metabolic syndrome, carries a very high risk of atherosclerosis. Consequently, coronary heart disease, peripheral arterial disease and cerebrovascular conditions are also highly prevalent in type 2 diabetes and these often carry a worse prognosis than when they occur in non-diabetic people. The combination of peripheral neuropathy (causing reduced sensation in the feet) and peripheral arterial disease (leading to reduced blood supply to the lower legs) is particularly serious and patients can develop serious lower limb or foot problems related to foot ulceration, sepsis or gangrene. The morbidity of type 2 diabetes therefore includes a wide range of serious conditions including coronary heart disease (the major cause of death), vision loss, kidney failure, lower limb amputation, painful peripheral neuropathy and strokes.
There are many effective preventive and treatment options available to those with access to good health care. However the management is complex and requires patients to take on healthy lifestyle measures and self-management practices and to engage in regular and life-long monitoring of blood glucose, lipid and blood pressure levels and in medical screening designed to detect treatable diabetic complications at an early stage. Patients may be required to use glucose and blood pressure measuring devices, self-administer insulin, take complex medication regimes, engage in daily foot care and attend for regular medical checks (family doctor, diabetes physician, ophthalmologist). In many countries, specialist educators (nurses, dieticians) run clinics for patient education and support. There have been many technical improvements with new medications including newer insulin variants, devices for easier administration of insulin, the emergence of point-of-care biochemical monitoring and wearable technologies for continuous glucose monitoring. Costs of care are enormous and beyond the capacities of many health care systems and the poor. Diabetes prevention appears to be feasible but the challenges at the individual and public health level are also immense (Simmons et al., 2010).

Disabling conditions in type 2 diabetes

It is not surprising that individuals with type 2 diabetes have an increased risk of suffering from chronic disability. Many diabetic complications are inherently disabling as are the predisposing conditions, obesity and low activity levels. Recent research suggests that the diabetic state itself may be independently associated with disability i.e. not directly explained by diabetic complications. Several studies have shown that patients with type 2 diabetes have greater impairments in mobility and more difficulties performing basic activities of daily living (ADL) than similarly aged non-diabetic people (Lu et al., 2009). In addition, type 2 diabetes has been associated with an increased risk of falls, fractures, depression and cognitive impairment. Most studies have focused on single topics and few provide an overall assessment of the impact of diabetes. In a recent Australian study, we reported on 223 diabetic subjects aged 70 years or over (Bruce et al., 2003). In this community-living group, ADL disability was seen in 53%, urinary incontinence in 27%, fecal incontinence in 11%, major depression in 14% and 15% had dementia and only 36% of the sample were free from such problems.
The disablement process is complex and involves social and economic factors, lifestyle-related risk factors (e.g. poor nutrition, obesity, smoking, sedentary preference), psychological factors (personality type, coping strategies), psychiatric conditions (mood disorders, changes in cognition) and a range of disabling medical conditions (arthritis, cardio-pulmonary disease, cancer, stroke) (Verbrugge and Jette, 1994). Most of these factors that contribute to disability are also important in the development of type 2 diabetes and its complications.
The extent to which disability in diabetes is gradually progressive or catastrophic, i.e. following on from a major event such as stroke or amputation, is unknown. Studies in the general population show that an impairment in mobility is often an early step in the progression to future disability. In our own study of middle-aged patients with type 2 diabetes, 18% developed new problems with basic ADL after 4.8 years follow-up (Bruce et al., 2005). There were multiple independent risk-factors for disability in this cohort including a history of stroke, peripheral arterial disease or depression, being a smoker and taking low levels of physical exercise. However, the strongest independent risk factor was mobility limitation at baseline consistent with the general literature. Reports of mobility impairment may be a useful early marker for preventative and rehabilitation efforts in diabetes. We also studied diabetic patients with normal mobility to identify possible causes of mobility limitation. Almost a third of our patients developed some degree of limitation after 5 years and again there were multiple independent causative factors that included the presence of peripheral neuropathy, arthritis and history of stroke (Bruce et al., 2005).

Falls and fractures

Prospective studies have shown that older women with diabetes have an increased risk of falls (Lu et al., 2009). The risk of falling is probably explained by the presence of peripheral neuropathy causing balance problems and gait abnormalities (reduced speed, shorter stride length and greater step to step variability) because of sensory and motor impairments (Allet et al., 2008). Other factors are also likely to be relevant including all the causes of mobility limitation listed above. Recent brain imaging studies have demonstrated that deep cerebral white matter lesions, common in diabetes and thought to represent chronic vascular ischemic damage, also increase the risk of falls (Blahak et al., 2009). In addition, diabetes has been shown to cause a more rapid loss of skeletal muscle mass than seen with normal aging (Park et al., 2009). In the limited studies currently available, sarcopenia occurs independently of neuropathy suggesting that this is yet another diabetic complication. Not surprisingly perhaps, the increased risk of falling is associated with a higher risk of fractures, especially at the hip. Yet, patients with type 2 diabetes do not seem to have an increased risk of osteoporosis (Khazai et al., 2009).

Dementia and cognitive impairment

Longitudinal studies have demonstrated that diabetes increases the risk of dementia, mild cognitive impairment and decline in a number of cognitive abilities (Cukierman et al., 2005). This problem appears to be confined to older patients in the main and may be due to the increased incidence of cerebrovascular disease. There is a current debate over whether there is also an increased risk of Alzheimer-related pathology in diabetes as clinical Alzheimer's disease appears to be more common. Some older diabetic patients have relatively subtle deficits in cognitive function that do not meet the criteria for dementia. Commonly, deficits in frontal-executive function are found, possibly caused by microvascular disease of the frontal lobes of the brain. Importantly, such deficits can be difficult to detect, yet are likely to have adverse effects on patients' abilities to self-manage complex diabetes management regimes. This possibility is worth considering whenever older patients appear to be getting into difficulties with their diabetes.

Depression and diabetes

Major depression occurs more commonly than expected in patients with type 2 diabetes. However the relationship between the two conditions is complex. Whilst patients with diabetes have an increased risk of becoming depressed, depression has also been shown to be a risk factor for the development of type 2 diabetes. It is likely that both situations occur, diabetes is a risk factor for depression and vice versa. Importantly, the combination of the two conditions carries a particularly poor prognosis and affected individuals generally have poor diabetic control and develop more or earlier diabetic complications (Egede, 2006; Black et al., 2003). Depression in diabetes appears to be amenable to conventional therapy but patients require an integrated approach that addresses both their physical and mental health problems (Egede, 2006).


There is relatively little evidence on the effectiveness or otherwise of standard rehabilitation therapy in patients with diabetes. However there is little to suggest that they do not benefit as well as their nondiabetic counterparts from standard approaches to assessment and rehabilitation. What is clear however from clinical experience is the complexity of problems that need to be dealt with. For example, the rehabilitation team may have to consider how to conduct stroke rehabilitation in a patient with chronic kidney failure who needs to spend considerable time periods undergoing renal dialysis. They may have to consider a patient with a recent amputation who also has visual or cognitive impairment (or both). Rehabilitating a patient with diabetic foot problems can be challenging as frequently the 'good' leg is also at-risk or already showing evidence of ischemia or impaired wound healing.
Diabetic patients undergoing rehabilitation require careful assessment, goal setting and good teamwork that will often involve multiple teams. The management of the underlying diabetes frequently requires modification. For instance, some patients require a simpler regime to enable a family caregiver to administer regular medications. In other cases, improved control of blood glucose levels may assist with wound healing or pain control (high glucose levels lower pain thresholds). It is not uncommon that the goal of achieving and maintaining close to normal blood glucose levels is no longer appropriate. In such cases, the advice of the diabetes treating team is often invaluable.
Exercise is one of the mainstays of treatment for type 2 diabetes and public health guidelines frequently update recommended frequencies, duration and type of exercise. Generally, trials of exercise have focussed on effects on control of blood glucose levels or cardiovascular risk (Bronas et al., 2009) and there is little published evidence on how to treat, prevent or limit disability in diabetic patients. Some interventions that have been demonstrated to be effective in older adults may be less effective in diabetes. For example, Tai Chi improves balance, gait speed and muscle strength in older adults but appears to be less effective in diabetes (Orr et al., 2006). On the other hand, a physiotherapist-supervised group training program was shown to be effective and resulted in improved balance and reduced fear of falling in patients with neuropathy (Allet et al., 2010). Given the increased focus on disability in type 2 diabetes evident in the recent literature, more treatment trials are to be expected in the near future.


Allet L, Armand S, Golay A, Monnin D, de Bie RA. 2008. Gait characteristics of diabetic patients: A systematic review. Diabetes/Metabolism Research and Reviews 24:173-191.
Allet L, Armand S, de Bie RA, Golay A, Monnin D, Aminian K, Staal JB, de Bruin ED. 2010. The gait and balance of patients with diabetes can be improved: a randomised controlled trial. Diabetologia 53:458-466.
Black SA, Markides KS, Ray LA. 2003. Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes. Diabetes Care 26:2822-2828.
Blahak BC, Baezner H, Pantoni L, Poggesi A, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Langhorne P, O'Brien J, Visser MC, Wahlund L-O, Waldemar G, Wallin A, Inzitari D, Hennerici MG. 2009. Deep frontal and periventricular age related white matter changes but not basal ganglia and infratentorial hyperintensities are associated with falls; cross-sectional results from the LADIS study. Journal of Neurology, Neurosurgery & Psychiatry 80:608.
Bronas UG, Treat-Jacobson D, Painter P. 2009. Alternative forms of exercise training as complementary therapy in the prevention and management of type 2 diabetes. Diabetes Spectrum 22:220-225.
Bruce DG, Casey GP, Grange V, Clarnette RC, Almeida OP, Foster JK, Ives FJ, Davis TM. 2003. Cognitive impairment, physical disability and depressive symptoms in older diabetic patients: The Fremantle Cognition in Diabetes Study. Diabetes Research and Clinical Practice 61:59-67.
Bruce DG, Davis WA, Davis TME. 2005. Longitudinal predictors of reduced mobility and physical disability in patients with type 2 diabetes: the Fremantle Diabetes study. Diabetes Care 28:2441-2447.
Cukierman T, Gerstein HC, Williamson JD. 2005. Cognitive decline and dementia in diabetes -systematic overview of prospective studies. Diabetologia 48:2460-2469.
Egede LE. 2006. Disease-focussed or integrated treatment: Diabetes and depression. Medical Clinics of North America 90:627-646.
Fetita L-S, Sobngwi E, Serradas P, Calvo F, Gautier J-F. 2006. Review: Consequence of fetal exposure to maternal diabetes in offspring. Journal of Clinical Endocrinology & Metabolism 91:3718-3724
Khazai NB, Beck GR, Umpierrez GE. 2009. Diabetes and fractures: an overshadowed association. Current Opinion in Endocrinology, Diabetes & Obesity 16:435-445.
King H, Aubert RE, Herman WH. 1998. Global burden of diabetes, 1995-2025: prevalence, numerical estimates and projections. Diabetes Care 21:1414-1431.
Lu F-P, Lin K-P, Kuo H-K. 2009. Diabetes and the risk of multi-system aging phenotypes: A systematic review and meta-analysis. Plos One 4:1-12.
Orr R, Comino E, Tsang T, Fiatarone Singh M, Lam P. 2006. Mobility impairment in type 2 diabetes: Association with muscle power and effect of Tai Chi intervention. Diabetes Care 29:2120-2122.
Park SW, et al. 2009. Excessive loss of skeletal muscle mass in older adults with type 2 diabetes. Diabetes care 32:1993
Simmons RK, Unwin N, Griffin SJ. 2010. International Diabetes Federation: an update of the evidence concerning prevention of type 2 diabetes. Diabetes Research and Clinical Practice 87:143-49.
Stumvoll M, Goldstein BJ, Vam Haeften TW. 2005. Type 2 diabetes: Principles of pathogenesis and therapy. Lancet 365:1333-1346.
Verbrugge LM, Jette AM. 1994. The disablement process. Social Science & Medicine 38:1-14.

Read this article in other formats and languages

Cite this article

Bruce DG. 2011. Type 2 diabetes mellitus and disability. In: JH Stone, M Blouin, editors. International Encyclopedia of Rehabilitation. Available online:


Copyright © 2008-2011 by the Center for International Rehabilitation Research Information and Exchange (CIRRIE).
All rights reserved. No part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system without the prior written permission of the publisher, except as permitted under the United States Copyright Act of 1976.
This publication of the Center for International Rehabilitation Research Information and Exchange is supported by funds received from the National Institute on Disability and Rehabilitation Research of the U.S. Department of Education under grant number H133A050008. The opinions contained in this publication are those of the authors and do not necessarily reflect those of CIRRIE or the Department of Education.

Sunday, March 13, 2011

Did NOT mean to scare anyone!

I have gotten a couple responses to my post yesterday about brain lesions, etc.  Toms Wife and Lynn both commented that they are not seeing this in their husbands.  I am very glad to hear that, as so many of us seem to be seeing cognitive changes in our husbands, and it is very upsetting and scary to watch.  Please understand that I in no way wanted to "scare" anybody with this article.  However, I did think several of us would find it more than a little interesting, as we have wondered more than once about changes we have noticed in our hubbies.  If anyone else has more information, I would be very interested.

Saturday, March 12, 2011

Brain Atrophy, Lesions Found in Type 1 Diabetics; May Indicate Cognitive Impairment in Diabetics Begins Early

 I was going through a paper pile in the basement today, and ran across this article I had printed some time ago, long before I discovered the blogs that "we sisters"  read, write, and/or comment on.  Managed to find the link, still on line.  Notice the date is almost 8 years ago!  I'm thinking this explains a LOT of what most of us are seeing with our husbands.  If I find any articles that are more recent, I will post them . . . or if any of you find some, please share.

Brain Atrophy, Lesions Found in Type 1 Diabetics; May Indicate Cognitive Impairment in Diabetics Begins Early

Release Date: April 7, 2003
BUFFALO, N.Y. -- Cerebral atrophy is common in young persons with juvenile-onset diabetes, and there is evidence that small blood vessels within the brain's white matter are damaged in these patients, neurologists at the University at Buffalo and the University of Western Ontario have found.
Both findings, which are preliminary, may be important in understanding the development of cognitive impairment seen in older diabetics, said Richard K.T. Chan, M.D., assistant professor of neurology and neurosurgery in the UB School of Medicine and Biomedical Sciences and first author on the study. Vladimir Hachinski, M.D., of the University of Western Ontario, is co-investigator.
"Although brain involvement in diabetes has been suspected, this is the first study that approaches the problem in a systematic manner," Chan said. "Persons with type 1 diabetes comprise a unique population, because insulin was introduced only about 50 years ago. These people now are entering the golden years, and their quality of life can be significantly impacted by impaired brain function."
Results of the research were presented at the annual meeting of the American Academy of Neurology held recently in Honolulu.
The investigations are part of the Study of Cognitive Impairment and MRI Abnormality among Diabetics (SCIMAD) being conducted by the two institutions. The goal is to determine the prevalence of cognitive impairment among young, otherwise healthy patients with juvenile-onset diabetes and to correlate impairment with neuroimaging results and clinical indicators.
This disease also is called type 1, or insulin-dependent diabetes, because the primary symptom is the inability of the pancreas to produce insulin, requiring patients to receive insulin injections throughout their lifetime. Type 2, or adult-onset diabetes, may be controlled by diet and exercise, although many patients with type 2 diabetes require medications (including insulin) to control their blood sugar concentration.
While prior studies have suggested a relationship between diabetes and cognitive functioning, the pathway through which the damage occurs is not known, Chan said. Impairment may range from poor school performance in childhood to decreased work output and forgetfulness in adulthood.
Formal testing of brain function often reveals problems in abstract reasoning skills, eye-hand coordination and other subtle impairments in brain function, Chan noted. More recent studies also suggested that diabetes is a risk factor for dementia, including Alzheimer's disease in the elderly.
One of the problems with such findings is that much research on diabetes and cognitive impairment, particularly that concerning cerebral small vessel disease (CSVD), has been done in older persons with type 2 diabetes, where outcomes may be affected by hypertension or other chronic conditions of aging, Chan noted. The SCIMAD study was designed to study the relationship in young, otherwise healthy juvenile-onset diabetics, in hopes of learning when and where the cognitive damage begins.
There were 26 diabetic and 24 non-diabetic persons in the cerebral-atrophy study, and 33 diabetic and 20 non-diabetic participants in the white-matter-lesion study. All participants were between the ages of 18 and 50. Diabetics were diagnosed before the age of 18 and had the disease for 10 years or more. The same study population was used for both investigations.
About half of the participants were enrolled through UB, the lead institution, and half through the University of Western Ontario. All participants received brain scans using magnetic resonance imaging that were analyzed for cerebral volume and the presence of ischemic white-matter lesions at the UB-affiliated Buffalo Neuroimaging Analysis Center.
Results showed that 23 of the diabetics, or 88.5 percent, had brain volumes lower than the median for control subjects.
MRIs of six diabetics, or 15 percent, showed ischemic white-matter lesions; none were found in the controls.
Researchers will conduct cognitive function tests and compare those results with the neuroimaging results when a full cohort of 100 diabetics and 100 controls has enrolled.
"The studies provide clues to the potential neurological problems associated with diabetes, including dementia and strokes," Chan said. "The next step is for us to identify the mechanism that leads to changes in structure, and perhaps we can design treatments to slow down or prevent disease progression."
The study was supported by a grant from the Juvenile Diabetes Research Foundation International.

Tuesday, March 8, 2011

Permission to leave . . . at least for awhile

 Yesterday, Diabetes Wife commented:

"I think it helps if we give ourselves "permission" to leave. I've found that it helps to physically leave when the discussion turns heated....even if he refuses to test and I know he is low. Lots and lots of Walmart visits....I can tell you where everything in the store it! LOL! It takes me 45 minutes to get there, buy toothpaste, come home. And by then, he has calmed down. Have 8 tubes of toothpaste in the bathroom drawer and realized I need to start picking up something else! :o)" 

Thank you so much for reminding me of this.  I haven't done it in awhile, because I am more of an outdoors person, and the weather has not been exactly warm lately.  But because of your comment, I actually started making a list of all the places I could go spend time when hubby gets impossible to be around.  Good therapy for me to actively figure this out! :-)  And the weather is getting warmer lately.  Took a long walk this evening with our dog, who always loves me and never criticizes anything I do.  I feel better already.  We also have more than one park fairly close to us, so I'm planning on getting a park pass.  That way, once the weather is warm, I can go to any one of these parks whenever I want, spend some wonderful, healing time, and get some exercise in the bargain.  Walking, swimming and kayaking . . . I can hardly wait for warmer weather, but I now also have a list of places I can spend time at right now, too!  By the way, funny about the toothpaste.  Guess you'll have to start stocking up on something else for awhile.    

Sunday, March 6, 2011

More thoughts on do I go, or do I stay . . .

Realize I haven't posted in awhile.  Just haven't had the heart to, I guess.  It has been a rather quiet week and a half.  Hubby and I went from not talking to each other at all, to finally hashing out some of the things that have bugged/hurt both of us.  When I told him that I had almost walked out the door, he said, "And I wouldn't have cared."  I asked him what if I didn't come back, and he said that it wouldn't have mattered to him at that moment.  Now my question is: It wouldn't matter to him in that moment, or not at all, ever?  Not sure I'm ready to ask him that one yet.

We did go on to actually discuss some things civilly with each other (wow, I caught him at a lucid moment!).  However, when I asked him what happens when he lashes out so viciously, I always get an "I don't know.  I just don't care when I am doing it."  I also shared my perception of things, and I did get a "sorry" from him, but really don't know how sincere it was.  During the conversation, he did ask me: "Why can't we talk to each other like this all the time?  I didn't know you felt that way."  And I told him that right now he was lucid, making sense, and not screaming at me.  Quite often if I attempt to initiate a conversation with him, it ends badly, so I quite often just don't bother anymore.  I think at that moment, some part of him understood what I was trying to say, but who knows how long he'll remember it?  Short term memory has been an issue for quite awhile, too.  So, I am here, for now . . .

Re-read a couple of posts today.  Crazy Wife's dad died a matter of months after her mom almost left him.  Would mom have ever been able to forgive herself if she had left so soon before he had died?  May seem stupid, but I worry about things like that!  Diabetes Wife also wrote today that maybe there are not a lot of diabetic's wives out there writing about this, as statistics show that 80% of them leave.  I guess we can all understand that!  I also agree with her that we need to support each other, as this is NOT easy, and who knows how long any of us will hang in there?  To all my sisters out there: know that you are special, loving, strong, amazing women.  We all need to remind ourselves of that on a daily basis!