One Saturday morning several years ago, on my way to the kitchen I noticed something peculiar about the molding above my front doors. There was a six-inch section of molding just above the point where both doors meet where if I didn't know better I'd think someone had punched it in with their fist.
In disbelief I walked up close and felt the molding with two fingers. What was left of the wooden molding in that spot crumbled and fell to the floor. You see, just underneath the paper-thin layer of wood was nothing but air. Termites had quietly and methodically eaten away the wood beneath the surface.
Curious to see if the termites had done any more damage, I felt to the left and to the right of the spot. Although the surrounding molding looked to be unaffected by the termites, I was surprised to see that when I poked on that area, it too collapsed, having nothing but air behind it.
After carefully probing all of the molding around my front doors, it turned out that all of it had been at least partially chewed on by the termites. In fact, I found that some of the termites were just sitting down for their next meal when I discovered them. What was most surprising was how, except for that one six-inch section of molding, the rest of the molding around my front doors had appeared to be fine, until I pressed on it.
Without poking at the molding you would never have known that the termites were destroying the wood around my door because on the surface everything looked fine. It was only after the termites had really done a lot of damage beneath the surface layer of wood that I noticed there was a problem.
This same scenario can be applied to type 2 diabetes. People will often take their diabetes casually, particularly if they don't notice feeling any different after they develop diabetes than they did before. When they hear that having abnormally high blood sugar levels will cause damage to many of their organs, they rationalize that somehow their bodies must be different because even with high blood sugars they still feel fine. They somehow believe that their bodies can handle the higher levels of sugar in the blood, like they have a higher threshold for sugar or something. After all, how could all those terrible complications happen when none of the affected body parts or organs ever hurt?
Consider this situation. Let's use you as my example. One day you wake up and your foot feels funny, like it is asleep or something. However, after breakfast, with teeth brushing and all grooming chores complete, your foot is still tingling, feeling somewhat numb. You misdiagnose yourself as having a pinched nerve from sleeping wrong and move on with your day.
Two days later your foot still feels peculiar and so you go to your doctor. After thoroughly examining you, the doctor says the problem sounds like neuropathy, damage to the peripheral nerves of the body caused by high levels of sugar in the blood. A review of the blood tests done at the doctor's office that day also indicates that there is some protein in the urine. This indicates that your kidneys are starting to become affected by the higher than normal amounts of sugar in the blood.
Later the same week, when you are at your eye doctor for an annual exam, the doctor sees some damaged capillaries in the back of your retina. This, the doctor informs you, is known as retinopathy.
Amazed at all the things the doctor has found wrong with you, you ask, "How come all of these things are going wrong with me all of a sudden?"
The doctor replies, "These complications did not develop overnight; they have been progressing from a stage when you don't usually notice them to the point, now, when you cannot ignore them. These complications have been coming on since the day the blood sugar levels first rose above normal. All of this time when you felt fine, under the surface, deep inside your body, these complications were getting started and gradually getting worse until, eventually, they became severe enough to notice."
You see the similarity between the termites and diabetes? Termites and higher than normal levels of sugar in the blood are both destructive. Termites gradually eat away at the wood until the damage is so great that the building eventually crumbles. But early on, when the termites are first getting started, their destructive work goes unnoticed. With diabetes the increased levels of sugar in the blood can initially damage small capillaries in various organs, going unnoticed. At this point the patient feels fine, mistakenly thinking this diabetes is no big deal. Eventually, however, somewhere in the future when the damage to the capillaries becomes severe enough, the patient begins to feel the pain and discomfort of the complications. Similarly, when the termites do enough damage, it becomes obvious the wood has been under siege by the termites.
The worst and most frustrating part of all of this is that once complications are present, the damage that has occurred to the organs will never go away. Regardless of how well you take care of yourself from then on, even if you become the model patient, the complications that are present will be there forever.
I stress to my patients in class in the strongest terms I know the importance of taking care of their diabetes right from the start. Even when the complications are already present, I emphasize the need for good diabetes control, as it is likely to prevent the complications from getting worse.
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