DAY 1 RDBlog week – Dealing With Other Diagnoses

Welcome to day one of RDBlog week the annual time when those of us who blog in the Rheumatic Diseases space blog about our life.  Today I am writing about interactions between conditions.  I chose the twisting roller coaster as the featured image because that is sometimes what I feel like as I try to sort out the three autoimmune conditions I live with.  Today’s prompt is:

Dealing – How do other diagnoses impact your RD and its treatment?

Most people who meet me, know within the first five sentences out of my mouth that I am married, I have two sons, three grandchildren and I have Diabetes.  I know that seems odd since I consider Rheumatoid Arthritis (RA) and Ankylosing Spondylitis (AS) to be the two most complicated issues I deal with.  It is type 1 diabetes that I usually mention first.

Diabetes

I have had diabetes for over 45 years, and in many ways, it has shaped my life as much as my 42 years marriage to Sheryl or our sons.  It has been a constant presence in my life, and to some degree I guess that makes sense because diabetes is the ultimate 24×7 disease.  I manage blood sugar almost by the minute, and I do finger sticks as many as ten times a day, I manage diabetes when I sleep, eat, work and play.

I wear a modern pump that helps me manage diabetes, and I consult that pump at least 50 times a day to see how my blood sugar is trending and to make tweaks to keep me in range.  I worry about having high or low blood sugar, if I am showing the early signs of a cold, too little or too much sleep and a thousand other things that will likely remain misunderstood and unnamed for the rest of my life.

With such a big concern, the prompt asks me to explain how RA and AS impact my diabetes.  In reality I think it impacts it very little.  I can say that the infusions I get  drive my blood sugar through the roof.  That happens for approximately 18 days a year.  During those 18 days I cannot use my usual pump, I have to give insulin via syringe, and I usually triple my dose of insulin for three days each time I have an infusion.  To understand the impact, consider that I typically use between 60 and 70 units of insulin on an average day.  Then find that insulin has to be tripled for 1-3 days to get my blood sugar under control. Overall, I am OK with this because it is a small inconvenience for the benefit I get from the ill effects of RA and AS.

But sometimes

On a typical day the three autoimmune diseases do not interact.    However, there are times when treatment can be fundamentally opposed to each other.  One such time is during surgery.  When I have surgery, I have to present in the operating room with my blood sugar at 150 or above.   Obviously during the period of twilight sleep or being completely out, I cannot manage my blood sugar, and the anesthesiologist does not want me to have a low blood sugar during the procedure, so they keep my blood sugar elevated.

This elevated state makes recovery far more complicated, my joints hurt far more, and my body tends to stiffen even as I consume liquid at a rapid rate to quench the awful thirst that accompanies high blood sugar.

Something similar happens when I have low blood sugar during the course of a typical day.  While I try hard never to have low blood sugar using insulin makes low blood sugar almost inevitable.  Recovery from low blood sugar can be difficult and  having RA and AS makes it so much more difficult to recover.  I know those of us who use methotrexate talk about brain fog.  Recovering from a low blood sugar is the same feeling for me.  While low blood sugar will almost always disorient me, having RA makes that disorientation last longer and be worse.

To answer the prompt, Diabetes and RA are typically reasonably peaceful. Of course I do not want any of these three monsters.  I have learned through trial and error how to deal with the three at once.  But when my body is stressed, really stressed usually by diabetes, that is when the interaction is the worst and problems seem to mount.

In short, immediately after a low or high blood sugar event is not a good time to ask me to solve math problems or do an in-depth reading.

After all, no one wants me to comment on a technical point by saying ahh, well, yeah, ahh, sure, I mean I guess if you say so Ahh.  Which is something I did in graduate school once and the professor asked if I was having a brain issue?  Oh no, I said, I had low blood sugar and I enjoy the benefits of RA.  After all you cannot get academic insight as inciteful as (ahh, yeah ,, I mean sure if you say so) without great eternal stimulus like these things in one person.

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