Type II Diabetes

I remember the first time this happened around 18 to 20 years ago.  I had just finished mowing the lawn one summer day.  The place we lived at that time had a larger than average lawn, with a slight hill in the back.  I went into the kitchen and was feeling exhausted, somewhat dizzy, light headed, nauseous, and of all things empty.  I don't know how to describe the empty feeling.  It was not exactly the same as being hungry, but it felt like my body was seriously missing something.  What calmed my body down at that time was a lot of Gatorade and cottage cheese.

The next couple of times I similarly exerted myself I experienced the same thing.  It was time to visit my doctor.  After running a few tests the diagnosis was Type II Diabetes.  At that time the only thing I knew about diabetes was that people needed to self medicate with insulin every day using hypodermic needles.  Horrors!  To my relief I soon learned that Type II Diabetes is a bit different in that insulin injections are not the usual treatment.  My doctor prescribed an oral medication and wanted me to start watching my diet, exercise more and lose weight.  Oh yeah, at that time I was considerably too far overweight.  Anyway, he said Type II Diabetes is usually managed in this way.  He also set me up with classes at the local hospital and with a home glucose monitor.

The classes were actually quite helpful.  I learned more about what Type II Diabetes is all about, and why diet, exercise and weight loss would be so important.  Complex carbohydrates are bad.  So it was time to pull myself away from bread and pizza and potato chips and beer.  Vegetables are good, and fortunately I actually like vegetables, especially raw vegetables.  Since that time I may have consumed a farm's worth of raw broccoli.

The glucose meter is a valuable tool.  It is used to monitor glucose levels in your blood at any given point in time. You plug a disposable test strip in the meter, poke your finger with a disposable lancet, have the test strip soak up a drop of blood, then note what the reading you get.  The range of "normal" is 70 to 99.  My readings at the beginning were in the 200's to 300's.  Another measurement taken at the doctor's office is the Hemoglobin A1C level.  It is my understanding that this also tests glucose levels but as a measured average of your hemoglobin from the past 30 days or so.  The A1C range of "normal is 4.3% to 5.7%.  My readings at the beginning were above 9.0.

Over time I lost some weight and got my glucose readings under better control.  Never perfect but controlled.

So what does this have to do with being transgendered?

Over the past few years when I began trying to find some way to somehow transition, I began to worry that my Type II Diabetes would prevent the possibility of beginning estrogen.  So I did my best to figure out if there was anything I could do.

I tried dieting more, exercising more and losing more weight.  I expected my daily glucose readings and my A1C level to improve.  However, my numbers were actually getting worse!  My daily glucose readings were in the 300's and closing in on the 400's.  My A1C was approaching 11.0.  How very disheartening!

I had already come out to my doctor a couple of years earlier, so at my annual physical last Spring I had a serious talk with him.  He was also concerned with the worsening of my diabetic indicators primarily for health reasons.  He said that as we age our bodies continue to lose the ability to produce & process natural insulin.  Additionally for those of us with Type II Diabetes, as we age medications begin to lose their effectiveness.  He had mentioned the possibility of beginning insulin a couple of times prior to this and suggested that it might be time for me to do so.  He was very good in allying my fears, explaining how beneficial it would be to take insulin and how the methods for taking it have changed.  At this point I was willing to try anything.

The next appointment I made in May was with a nurse at the local hospital's diabetes center.  She went into more detail regarding diet and exercise, as well as more detail regarding how insulin is taken.  She said the vials of medication with accompanying hypodermic needles are still available and are actually preferred by many patients (not me!).  However, there is a newer delivery method available which yours truly accepted, which is a pen-based delivery system.  The insulin comes in a device that looks like a fat ink pen.  One dose per day.  You attach a small disposable needle on one end, select the dosage by turning a dial on the other end, and inject the dosage into yourself.  The disposable needles are ultra small and the momentary "stick" is less painful than the finger prick for a daily glucose test.  She started me at a fairly low dosage and explained that we would adjust it depending on its effect.

I kept the diabetes nurse appraised of its effectiveness via email, by sending her my daily blood glucose readings.  My glucose numbers began falling.  This was great!  We gradually increased the dosage to where my glucose numbers were very close to normal, not perfect but much better than before taking insulin.

By late July the diabetes nurse suggested a second medication that replicates a natural hormone our bodies produce called GLP-1.  I had never heard of this hormone before.  My understanding is that GLP-1 is released into the small intestine when we eat and slows the process of food leaving the stomach.  Food is processed more effectively.  GLP-1 triggers cells in the pancreas to make natural insulin when your blood sugar is too high.  So I read more about this medication and agreed to give it a try.  It comes in a pen-based delivery system, just like the insulin.

After taking this additional medication a few weeks my blood glucose numbers were averaging closer to normal than ever before.  In August I visited my doctor and we were both surprised to find my A1C had gone down to 8.5%.

By this time I had decided to move forward with transitioning.  I had found a doctor at a nearby university hospital who is also a transgender specialist.  After noting my health history and much discussion, she prescribed my hormone treatment!  This was a such a validating moment for myself, a major milestone in my path toward living an authentic life.  By September she had started me on low dosage estrogen patches and low dosage Spironolactone tablets.  Since then she has gradually increased both dosages.  More on hormones in other postings.

I've continued taking insulin and the GLP-1 replicator.  I've just had another check up with my doctor.  I knew my glucose readings were very good and I was looking forward to finding out where my A1C level was at.  Well dear readers, my A1C was at 5.7%!  This is the upper end of the "normal" range.  My doctor & I were both surprised.  He was very happy for me and I could not stop smiling.  My A1C has never been this low for the past 18 to 20 years.  My other basic health statistics were also very good:  blood pressure, cholesterol, etc.

I have begun to notice gradual changes with my body due to the hormone treatment.  But I still don't have as much of a girlish figure as I would like.  Not yet.  I am still overweight.  So.  Now that I have my health and diabetes under much better control it is time to get serious about weight loss.

Message to Sue

Dear Sue,

When I came out to you more than three and a half years ago I fully expected rejection.  During this time you have read and learned so much about gender issues.  You know that statistically very few spouses choose to remain in the relationship when their partner comes out as transgender.  Yet you choose to go against those statistics.  You choose to keep our relationship growing.  You have been more accepting and understanding than I ever dreamed possible.  You accept me as a woman, and you do not worry what the world might think of that.

I truly believe we've become closer during the past three and a half years than the previous thirty.  Although, despite my having kept my gender issue secret all that time we still managed to build a great relationship.  I think this has created the solid foundation that has helped to hold us together.  We've talked about this and you know that I do believe you to be my true soulmate.

Something I would like to attempt to explain are those moments when you have caught me "zoning out" as you have called it.  Most of those instances are when my depression, my darkness finds its way to the surface for a bit (as I talked about in that last blog entry).  There is no sane reason why I should have bouts of depression, but I do.  I try to tamp it down, to hold it off, but it still gets to me occasionally.  And you know me so well that you almost always notice when it occurs.

Most of the time it lasts a relatively brief time, runs its course and then I'm fine.  Having it last for a number of days is an exception which I hope to be a rare occurrence. 

Just know that when I experience these bouts of darkness I always know that you and your love are there with me.  I could have no better rock solid support than that. No amount of depression can last overly long against the strength that is you.

Thank you so very much!

All my love is forever yours.

Ahhh ..... The Memories

They say the holidays can be a bad time.  They generally haven't been that bad for me in the past.  But this year......

It really started around Christmas day and has been hanging around every day since.  Sadness, emotion, depression.  It could be the hormones but I suspect there's a bit more going on.  I keep reflecting on the way it was as a teenager and a young adult. 

I did a great job keeping it to myself but I was so very confused and scared and angry and sad and depressed.  What a way to live.  Feeling so very alone and figuring that it would always be that way.  It was the late 60's and early 70's and I was in the heartland of Iowa.  Here I was, a girl stuck in a boy body, confused about my gender, confused about my sexuality, but knowing damn well that there was no way I could allow any living person find out about any of this.  I didn't believe there could be anybody else like me.  I barely understood what being homosexual meant much less know of anyone that felt "different" in this way.  There was no one I felt safe enough to talk to about what I felt, not parents, siblings, teachers, classmates ..... not one other person.

I don't know how I ever got through that.  Somehow I learned how to live a double life.  On the outside I appeared the same as any other awkward and shy guy, but inside I was a messed up girl.  I used to say that I never considered suicide but to be honest hat option was always there, lurking in the background.  During that time I relied much too heavily on drugs & alcohol to numb myself from the impossible incongruity of who I was.  There were three distinct instances during that time that should have resulted with my end, but for whatever reason Fate kept me in the game. 

I somehow understood that there were certain things I had to do to if I was to continue existing.  I had to have my own place to live, I had to have my own transportation, I had to have some kind of income.  So after wasting two years at one of the state colleges, I quit school and got a factory job.  Perfect.  Semi-mindless work for decent pay, and I had the means to exist.  After some time drifting through life that way my soulmate appeared in my life and everything changed.  But that will need to be told later.  This entry is all about my sadness and depression, my darkness.

Here I am, finally living as fully as possible as the woman I am.  I should be joyful & happy, right?  I should be ecstatic.  I guess part of me is.  But my life isn't a perfect bed of lace & roses.  As the past few days have shown there is still a bit of darkness hanging like a thundercloud on my soul.  Mostly I am able to keep a lid on that darkness but it does find some way to rise up now and then.  I've been hoping to find some way to get rid of this negativity, but I'm afraid it might always be a part of me.

I must admit that I do have a decent life and I do realize how fortunate I am to finally be able to live my life the way it is supposed to be.  There is no sane or logical reason for it, but it seems that some of the dark will always be near at hand.