The Health Blog

Several warning signs are common to both types of diabetes:Extreme thirstFrequent urinationUnusual tirednessIrritabilityNausea and vomitingUnexplained and rapid weight loss (more common to Type I diabetes)Symptoms more common to Type II diabetes include:Delayed healing of wounds Recurring skin/gum infections Pain or tingling in the legs or feet Occasional blurry vision  Unusual drowsiness Sudden weight gainImportant: (i) Diabetes can be present without any of the above symptoms, or with only mild or vague symptoms such as feeling “run down.”Often it is discovered very incidentally, say, when a routine urine test is done prior to surgery or for an infection of boils, perhaps.(ii) Pregnant women should be tested for signs of “gestational diabetes” between the fifth and sixth months of pregnancy. This is a temporary, diabetic-like condition caused by the hormonal changes of pregnancy. It must be treated on the same basis as diabetes: first with diet control and, if that doesn’t work, withdaily injections of insulin.       All the symptoms of diabetes are a result of the high levels of glucose circulating in the blood. When these levels peak, large amounts of glucose are excreted in the urine along with large amounts of water. This causes the frequent urination that is one of the symptoms of diabetes. The excessive fluid loss also leads to extreme thirst — another of the warning signs of diabetes. Along with the water, essential body salts like sodium and potassium are lost — and a gross deficiency of these salts can be more serious than the water loss itself. If the loss of fluids and salts is excessive because the diabetes is not well controlled, it can even bring on a life-threatening condition known as “dehydration coma.”Because sugar is not moving normally into the cells, they are starved of glucose, the body’s fuel, resulting in tiredness, drowsiness, irritability.*63\332\2*

Anna is now aged thirty-eight, and has a lively sixteen-month-old daughter, Esme: it seems incredible that her first symptoms of breast cancer appeared when she was only twenty-two years old. Anna, a nurse, noticed a white discharge from one nipple and went to her doctor who sent her for a mammogram. The mammogram came back clear and she went away content that she was in the clear. But over the next few years she repeatedly went back to the doctor – she saw a total of five GP s – with a number of classic breast cancer symptoms: orange-peel skin, inverted nipple and a ‘fixed’ breast. She was repeatedly told that the original mammogram was clear and that she did not need to be referred to a specialist; even a follow-up mammogram was deemed unnecessary. It was also implied that because of her nursing background with all the cancer patients she had tended, Anna was developing slight hypochondria. Finally, she refused to leave the doctor’s surgery until she was referred on. Seven years after the first symptom, breast cancer was diagnosed. Anna had a mastectomy, followed by a very successful reconstruction with a silicone implant.     Anna’s backlash of anger when she went through the whole experience meant that she began over-eating and, inevitably, put on weight. She has calmed down now and her family’s eating habits are pretty good – mostly vegetarian or fish-based meals, lots of fruit and vegetables and organic food dominate the dining table.     When Anna’s daughter was born nobody could advise her on the likely problems associated with breast-feeding from one breast, and no literature was available. Finally, she consulted books on breast-feeding twins, had no problems, and continued feeding from her natural breast until her daughter was over one year old. It is astonishing that she was given quite worrying information along the way by well-meaning but misinformed people. It was suggested that there was a chance of passing on cancer in breast milk (you can’t) and that another pregnancy would be likely to increase the risk of recurrence of her breast cancer (the opposite is true).     One thing that Anna has learnt through all this is to listen to her own instincts and ignore advice which she believes to be fundamentally wrong. I came into contact with her when she wanted information to resolve a health problem her daughter was experiencing. A paediatrician had said it was definitely not linked to diet – but it was. A nine-month problem was resolved in a few days by a simple adjustment to her daughter’s diet. Anna now listens to her inner wisdom.*39\240\2*

What makes HIV infection different is death at an early age in the midst of the deaths of many friends. Most people who die of HIV infection are in their thirties. Someone who has HIV infection probably knows many others with the disease.     Because they are young, they have worries about dying that older people do not. Young people have less time to get used to death gradually. They are not yet tired of living. They have not slowly come to see themselves as dispensable and mortal. They do not understand what to do about mortality, how to sum up and conclude their lives. “I have to face my own mortality,” said Steven, “which I didn’t expect to face until I was eighty.” They look at their relatively short lives and ask questions they are not used to asking. “Usually people ask in their sixties, ‘What have I accomplished?’ Alan said. “I’m going to have to ask that earlier.” They often feel resentful that they must ask these questions so early, and they feel unready to supply the answers.     They also worry about dying before their parents. They want to be able to help their parents out as their parents age. “Now I’m looking at dying before my parents,” said Dean. “That changes the natural process. It hurts.”     Because people with HIV infection often know others who are dying of the disease, they have concrete images of what will happen to them. They visit their friends in the hospital and think, “Is this what will happen to me? Is this what I will look like? Is this what I will feel?” “I know what the last few months are,” said Alan, “and I wish I hadn’t seen the suffering. Knowing what it looks like is difficult.” Dean lost twenty friends in two years. “It gets stronger with each one,” he said. “Closer to home.” People with HIV infection say too much death surrounds them. “I have so many friends who are disappearing,” Steven said. “In one year, I went to twenty-six funerals. I sit at the funerals and think how wonderful the person was, and how they looked before the end, and how long will it be before I’m there.” For that reason, some, like Steven, no longer go to funerals. Alan said, “I’ve been to forty-seven funerals. That’s my limit.”*222\191\2*