Monday, September 01, 2008

100 Medical Things I've Learned

Today marks two years since an IV was stuck into one of my arms, and four bags of fluids started dripping down into veins. The second IV wasn't inserted until the 2nd because the first 6 sticks didn't get a vein. Today marks two years since a doctor promised me that in just a few days, I'd be feeling much better. Today marks two years since I came back to life. My father says that watching me during my first hour on insulin was like watching an inaminate object become animate- that's how different I looked. I was interested in medicine and disability long before diabetes, but diabetes has certainly changed the directions in which I've learned.

This is a list of 100 things I've learned in the last two years. Half of them are things I learned because I have diabetes, directly or indirectly; half of them are things I learned just because I am interested in the ways that bodies work. I can provide sources if you leave a comment wanting to know about a few, but I'm not going to find where I learned each one otherwise. I originally intended to make a list of 200 things, but it was taking too much time. A lot of these could probably be divided into two things though.

*1) Although the kidneys secrete most things proportional to their presence in the blood stream, glucose is the exception.

&1) Hemophiliacs typically have reduced levels of clotting factor, not an absolute deficit.

*2) Glucose is filtered by the kidneys in a piecewise function: f(x)=0 for xa. a is the renal threshhold.

&2) A normal human spine has a slight curvature. Unusual curvature, or scoliosis, can threaten the heart and other internal organs.

*3) Gastroparesis is gastic nerve death, and it causes slow digestion, abdominal stiffness, throwing up, and other gastric woes.

&3) Effective surgical anesthesia was not widely available until the mid-nineteenth century. The anesthetics used had been available for recreation use for forty years prior.

*4) Most mild cases of gastroparesis go undiagnosed. Of diagnosed cases, half are in diabetes. Between a fourth and a fifth of all T1s will be diagnosed with gastroparesis.

&4) Bites precipitate 1% of ER visits in the US. The three most common biters responsible are dogs, cats, and humans.

*5) Of ER visits due to drug reactions, insulin is the drug most often responsible.

&5) Immunotherapy, or measured increases in exposure to promote tolerance of a foreign substance, works for rabies as well as for allergies.

*6) Most autoimmune disease are more prevalent in females. The human autoimmune for of diabetes is the most prominent exception to the rule.

&6) Leukemia kills more adults than it does children. Some forms of leukemia are chronic illnesses.

*7) The only suspected cases of type 1 diabetes transmission involved diabetics donating bone marrow. The marrow recipients developed T1 diabetes.

&7) Allergies are always an IgE response to proteins. No protein, no true allergy.

*8) Injections typically fall into four categories: transdermal (into skin), subcutaneous (into fat), intravenous (into vein), and intramuscular (into muscle).

&8) Service dogs can help people with short term memory loss by prompting them and by warning them of danger. Less than half of service dogs serve the blind.

*9) Some dogs and cats can smell hypo and hyper glycemia.

&9) Imprinted genes are ones where which allele comes from which parent makes a difference in how the gene is expressed.

*10) The genes implicated in type 1 diabetes are paternally imprinted. That's why having a father with T1 confers 4x the diabetes risk that a mother with T1 does.

&10) Viruses become more mutagenic when passed through the blood of multiple people, as when blood recipients donate blood. This may be how SIV turned into HIV.

*11) Celiac Sprue is most common in people who have at least one R3 allele. 60% of T1 diabetics are homozygous R3/R4. T1s and their siblings have a 5% chance of developing celiac.

&11) People with Down Syndrome have a 5% risk of developing diabetes. They also have a 5% risk of developing celiac sprue.

*12) The primary function of the pancreas is to produce digestive enzymes. Early attempts at isolating insulin failed because the pancreatic extracts digested themselves.

&12) Fluctuations in testosterone level are responsible for some mood swings, but absolute testosterone level rarely is.

*13) Fluctuations in blood sugar level are much easier to feel than absolute blood sugar level. They are also probably more dangerous to the body.

&13) People typically have an increase in growth hormone production in the early morning.

*14) Growth hormone causes insulin resistance, and the early morning insulin resistance from growth hormone is called the Dawn Phenomenon.

&14) The cost to inject growth hormone in one person for one year is typically 20,000- 30,000 dollars. Children in the bottom 1% of height, as well as anybody with an absolute deficiency, is legally eligible to take growth hormone.

*15) After carbohydrates are digested, about half of them are stored in the level, for continuous slow release.

&15) Prolactin is a hormone whose levels are controlled by the pituitary gland. Tumors of the pituitary, which are fairly common, can result in high levels of prolactin.

*16) Bodies can convert some protein into glucose.

&16) For HIV positive men who want to have children, there exists a procedure called washing, in which the sperm are isolated from the semen. Sperm are not contagious.

*17) An acidic compound called a ketone is the waste product when people burn fat. A build up of these acids is ketoacidosis, and the most common causes are lack of insulin, and alcohol withdrawal.

&17) Most schizophrenics smoke cigarettes, but they don't get lung cancer. They do get other health problems from smoking.

*18) Being overweight is a good sign if you happen to have Type 1 diabetes. It means you're getting enough insulin. Overweight T1s live longer.

&18) Human weight is supposed to peak between the ages of about 55-60. People who are skinny at 60 may have difficulty living through the strains that age places on bodies.

*19) Even mild vitamin D deficiency in children is a strong risk factor in the development of type 1 diabetes- though whether the deficiency is the cause or effect has not been proven.

&19) Vitamin D deficiency sometimes happens to people who spend all of their time indoors/ wearing lots of clothes, and who don't eat diets rich in vitamin D.

*20) Veins are larger when people are hydrated; it is very painful to have blood drawn during severe dehydration.

&20) Drinking a lot of water can flush important stuff from the body (see *1).

*21) Diabetes can cause blindness in multiple ways. 13% of new cases of blindness in adults in the United States are from diabetes. More than 90% of diabetics have eye damage from diabetes after 20 years.

&21) Rheumatoid arthritis can cause sudden blindness. One of the first people to go around the world, James Holman went blind from arthritis at the age of 25.

*22) Rheumatoid arthritis is an autoimmune disease. Juvenile Rheumatoid Arthritis has onset exclusively in children, while 5% of people with the adult form are diagnosed before the age of 18.

&22) Rosacea is a condition in which the skin and/or eyes become flushed, chronically. It is only dangerous when it happens in the eyes.

*23) Heart Failure means that the heart isn't pumping out enough blood with each beat. People can live in heart failure for a long time.

&23) Stomache cancer is usually a form of food poisoning.

*24) Insulin is slightly carcinogenic. Insulin resistant people are at higher risk of cancer because they use more insulin. The only commercial insulin known to be more carcinogenic than Toronto is Lantus.

&24) The Yellow Fever Epidemic of 1793, which took place in Philadelphia, was the prompt for the first published criticism of racism in the United States.

*25) Diabetic neuropathy can affect the sexual function of both men and women. Many men with diabetes also have abnormal sperm production.

&25) Cystic Fibrosis is the most common reason for people to need double lung transplants. If a CF patient gets only one new lung, the CF destroys the new one; with a double lung transplant, no cystic fibrosis occurs in the new lungs.

*26) Almost 100,000 people are waiting for new kidneys. 3,000 are waiting for kidney-pancreas transplants.

&26) Breast size continues to be dependent on estrogen levels after puberty- a fall in estrogen levels will reduce breast size. It'll also reduce breast cancer risk.

*27) The first American to benefit from insulin injections was diagnosed with diabetes at the age of 15; put on insulin at 22; died at 61 from prostate cancer.

&27) Making the exhalation longer than the inhalation is calming. Calms me down enough to sleep through dentist visits.

*28) Dogs with diabetes are often eager for shots because they know that a shot means that food is coming soon. Wouldn't it be nice if humans were so trainable?

&28) Seizures typically result from too much electricity in one part of the brain (partial onset) or the entire brain.

*29) Hypoglycemic seizures typically start below 45 mg/dl. The seizure itself tends to raise blood sugar.

&29) Some people don't mind having seizures, or even enjoy them. Others experience terrible pain and/or anxiety.

*30) Most adults experience fluctuation in insulin sensitivity based on monthly fluctuations in sex hormone levels - even men!

&30) Acne breakouts are often precipitated by changes in testosterone levels. The dramatic cycles women experience explain why men are more likely than women to outgrow acne.

*31) People need insulin even when they're not eating. See *15.

&31) Metabolism slows down as people age. Renal threshhold increases.

*32) During DKA, potassium leaves the cells, goes into the blood stream, and gets filtered out by the kidneys. Dangerous potassium depletion results.

&32) Having a balance of sodium and potassium levels is usually, but not always, more important than absolute levels of sodium and potassium.

*33) Potassium is one of the most bitter substances necessary for survival. YUCK!

&33) Tardic Dyskinesia is the name of a side effect of many psychotropic medications, including lithium. It is an inability to control, or to promptly control, many small muscles at first, and others later, and is what many people think of when they think of the mentally ill.

*34) Sugar is not more dangerous to diabetics than other carbohydrates are. For me, sugar is easier with insulin than protein is.

&34) People who regain sight or hearing after long periods of blindness or deafness have sensory integration problems that improve with time, even though those of us born with sensory integration disorder tend not to improve much after reaching about puberty.

*35) Injections are least painful when they go into subcutaneous tissue (ie fat).

&35) The term shot, used to mean an injection, began to be used towards the end of the first half of the twentieth century, and was still considered slang in 1960.

*36) Autoimmune diseases are more common in lefties.

&36) The children of two left handed parents have a 50% chance of being left handed.

*37) The only vaccination that makes a difference in the long term likelihood of a person being diagnosed with type 1 diabetes is the TB vaccine.

&37) The usual TB test is an intradermal injection (although sometimes messed up and made a subcutaneous injection) that provokes a skin reaction in people with TB antibodies as well as those who are allergic to the ingredients in the shot.

*38) The first insulin intended to last longer than regular and commercially sold was PZI insulin, or protamine zinc insulin. Almost all insulin mixes since have contained zinc.

&38) NPH insulin is sold on the steroid black market (even though you buy it over the counter) as a weight gain tool. Way too dangerous, in my opinion.

*39) Going bald is an itchy proposition. Ugh. I was balding from malnutrition when I was diagnosed with diabetes.

&39) The brain can't process both deep pressure and pain sensations at the same time, which is why rubbing makes owies all better.

*40) A low fiber diet is one of the more effective dietary treatments for gastroparesis.

&40) Absolutely 0 gluten is the most effective dietary treatment for celiac sprue.

*41) Although most autoantibodies only increase risk of developing one disease, GAD 65 is implicated in type 1 diabetes, type 2 diabetes, Stiff Person Syndrome, and a few other neurological conditions.

&41) The flu vaccination is available in both the live and dead forms. The live form is the more common one. The vaccination is even available in nasal spray form.

*42) Risk of almost all infectious diseases is increased for diabetics. Risk is greater with worse blood sugar control, but does not decrease to 0 with intensive therapy (A1c below 6).

&42) Insulin shock therapy was once used like electric shock therapy continues to be used today. It was not effective in treating depression, and was discontinued in the main.

*43) When venous blood sugar levels drop below 45 mg/dl, the difference in brain function is visible on EEGs.

&43) It is illegal to drive in the state of IL with a disorder that your physician believes may give you 1 or more seizures per year.

*44) Glucagon is a hormone produced by alpha cells, in the islets on the pancreas, and it signals the liver to release glucose.

&44) Hormones are either water soluble or oil soluble. Oil soluble hormones are steroids by definition.

*45) Red blood cells are basically bags of hemoglobin. A portion of the hemoglobin is bound to sugar. What portion of the hemoglobin is bound depends on how long the hemoglobin lives for and what the ever blood sugar level is.

&45) Although the normal range for red blood cell counts of men and women overlap, the male range is about 10% above the female range. This is entirely testosterone dependent.

*46) Neuropathy itself is usually not a reason for amputation; it creates a strong vulnerability for infections and accidents. Smoking quadruples diabetics' major limb amputation risk.

&46) The vast majority of deaths in people with end stage renal failure are directly caused by either poisoning, from eating things the kidneys aren't there to clean out of the blood, or infection from the dialysis sites.

*47) Diabetics on dialysis typically have A1cs in the 6s and 5s because they don't eat much.

&47) Hemodialysis patients who have poor tissue health in the conventional dialysis sites can be dialyzed through the neck.

*48) Peritoneal dialysis offers a better prognosis than hemodialysis EXCEPT for diabetics. Peritoneal dialysis patients typically report a higher quality of life.

&48) DHEA is a hormone that stimulates production of sex hormones. It is an over the counter medication in the United States but prescription only in Canada.

*49) The normal blood sugar range of pigs is 20-80 mg/dl.

&49) 5-15% of the general population is stereoblind, meaning that we (I'm stereoblind) lack binocular vision.

*50) The body's ability to hormonally react to hypoglycemia decreases with duration of diabetes treatment regardless of level of blood sugar control.

&50) A gelastic seizure is one that features uncontrollable laughter or crying. They aren't thought to be very common.

1 comment:

Molly said...

Interesting facts, Jonah. Thanks for sharing them. I particularly liked the one about dogs alerting for high and low blood sugars! :-)