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.
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