And, MAYBE, I’m finally prepared to act.

My progressive exercise program has transitioned from walking twice a day to walking once a day to stationary-biking once a day to basically nothing.

As I experimented with taking less and less insulin and finding that doing so did not immediately send my blood sugar levels skyrocketing, I gradually convinced myself that I didn’t need any at all. It was a small step from taking no insulin to doing no blood glucose monitoring. And with that check on my body’s response to what I was putting into it out of the way, I began to feel more and more at liberty to indulge all those food cravings that had never diminished.

About the only thing I haven’t done is start smoking again. And to be frank, in the past couple of days I’ve had some cravings along those lines for the first time in months!

I’m getting very much out of control, and the effects (while somewhat subtle) are significant enough to already see.

Here are the numbers.

My surgery was on 15 March 2006, about six and a half weeks ago. I weighed about 305. Immediately after surgery my weight went as high as 315 due to edema. I came home at 299, and watched it steadily drop (with the assistance of the diuretic HCTZ) down as low as 281. This morning it was 291.6. Two hundred ninety-one point six. And, no, that’s not some sudden abberent overnight spike. It’s been edging back upward, a little bit almost every day, for the past three weeks or more.

My blood pressure has also been going up, daily, during these last couple of week or so… as high as 190 over 118. My cardiologist had made some changes in my hypertension medication recently, but I strongly suspect that my food indulgences are more to blame.

I have to regain control. Either that or I should simply tell Lara that I’ve decided being lazy and bingeing on all the wrong foods mean more to me that trying to get healthy enough to be around for a few more years.

It’s extremely frustrating, intensely depressing. And how have I always dealt with emotional turmoil? By feeding my fat face. I have to stop, but it’s as if I don’t know how to stop… which to anyone else I’m sure sounds like a cop-out. I feel that I’m reaching a critical point in a gravely serious situation. I cannot afford to ignore this, to back-burner this. If I go on auto-pilot I know what the outcome will be.

The thing is, so much has happened that it’s going to be difficult to even summarize it all So what comes next is going to be more of a strange sort of highlights reel.

Going back to work on Monday the 10th was nice. Several coworkers expressed some genuine, sincere, really-glad-you’re-back sentiments. Some others felt more comfortable going the route of good-natured kidding: “It’s about time you got back,” or “Some people will do anything for a few days off!” It was all appreciated. It was very pleasant to sense that I had really been missed… and even that my absence had raised some awareness of just how hard I worked there, of the volume of work that I did.

Two months or more ago I had been promised that, just as soon as circumstances allowed, I would be transitioning away from my responsibilities in human resources and payroll into a new role — IT. No, not “it”… Eye Tea …the magical enchanted land of Information Technology. For me, in many ways, a dream job.

Basically, since about the time I bought my first “real” computer (a very used, very bare-bones 286 with a 40 Mb HD and not enough memory to run Windows 3.1), I have realized that I love working with computers. The more knowledge, the more skills I acquired the more I enjoyed time at the keyboard. I revelled in the fact that I was virtually entirely self-taught. But when I did finally take a couple of programming classes at the U of A, it felt like cominghome to a world I had never seen before.

So, on the 10th I was more than anxious for the transition to begin… and more than a little disappointed that it did not commence immediately.

In retrospect it’s clear that my expectations were somewhat unreasonable. I was sort of expecting our Director of Systems Administration to put everything else on hold while he got me up to speed in my new duties. The truth is that there was (and still is) MUCH for me to learn.

I’ve always taken pride in being a “quick study,” but these days that doesn’t seem to come as easily as it has before. I’m willing to attribute part of that to effects of the stress of recovery from the surgery, but I also suspect that part of it is simply…age. During these past two weeks there have been good days and there have been bad days in terms of how my body feels. Bad “physical” days hold me back mentally. I don’t seem to learn as fast, think as quick or as clearly as I should.

Staying on this multi-faceted (low sodium, low saturated fat, low cholesterol, no simple carbs & low-carb overall, etc., etc.) diet is just hard. I’m doing o.k. with breakfast and lunch by preparing my own protein shakes. I blend whey protein powder with a couple of raw eggs (or equivalent amount of egg-substitute) and either 6 oz. of nonfat yogurt or 6 oz. of organic nonfat milk. They keep my blood glucose steady and stave off hunger for 3 to 4 hours. By dinnertime, though, on most days I’m ready to chuck it all and eat whatever I feel a craving for.

Sticking with the progressive exercise program is proving to be at least as much of a problem. I’ve been experiencing severe pain and some swelling in my feet that seems to be a result of simply being on them more now that I’m working again instead of sitting at home all day either at the computer or in front of the television. My right leg (the one from which the vein was removed to be used for grafts) is still rather swollen and is painful much of the time. The incision wounds are healing, but seem to me to be doing so rather slowly. They are still very ugly looking.

Lara and I bought a recumbent-style exercise bike, in an effort to provide a “lower-impact” alternative to walking. Most of the time, though, I find myself feeling that I have zero energy. Most nights I’m sleeping poorly. I get up in the morning feeling tired and by 5:00 in the afternoon I feel exhausted. So the bike has not been being used much by me.

I know I have to find the will, however, to get back on track with both diet and exercise. It has to be done to help ensure decent long-term health for me. I also recognize that the better my body feels and functions, the better my brain is going to be capable of working. And this new, dream job is all about the brain.

I've decided that I'm going to go to work tomorrow for a little while.  Mainly I feel the need to just begin getting reoriented there. I probably won't stay for more than two or three hours.  The task of moving from my old office into the new one (which was almost ready to happen mid-March) will have to wait a few more days, though.

If all goes well, I'm planning to return to work more-or-less full time on Monday, the 10th.  I'll round up some guys with strong backs perhaps that day.

Hmmm.  I just realized, Monday will be exactly one month since the last full day that I worked.  

It's about time! 

Therefore, the prospect of injecting insulin into myself four times a day, every day, for the rest of my days holds no appeal for me. Neither does spending well over two hundred dollars a month for insulin and syringes. Shelling out $130+ per month just for testing supplies is more than sufficient.

In short, I want to "un-diabetic" myself.

At the very least, I want to become a non-insulin-dependent diabetic.

Is that too much to ask?

Before my heart surgery, I had never been told by a healthcare professional anything like, "Your blood sugar is a little high; you'd better keep an eye on that." And as part of various blood work done for various purposes, in the last six years or so I have had blood glucose checked on average at least once or twice a year. No, so far as I know, on March 16th I was a diabetic. On March 14th I wasn't.

I've tried more than once to discuss with my endocrinologist the long-term possibility that regular exercise plus significant (maintained) weight-loss could equal insulin independence, but he does not even want to talk about it.

So I've decided that I'm just going to do it. It's something that I'm going to work at until I achieve it. And once I do achieve it, that's a very special type of independence that I'm never going to give up again.

I'm up to walking 20 minutes twice a day now, and I will be increasing that progressively. I'm struggling some with portion sizes and late night snacking to keep the weight-loss going, but right now I weigh approximately 20 pounds less than I did a month ago.

I am also looking into nutritional supplements that have demonstrated the potential to increase insulin sensitivity [e.g., chromium, vanadyl sulfate, and alpha-lipoic acid]. I have begun taking "fish oil" for Omega-3 Essential Fatty Acids, and evening primrose oil for Omega-6 EFAs. I'll discuss more my personal supplementation program as it develops and changes. For now, one little tidbit:

Keen, H., et al. Treatment of Diabetic Neuropathy with Gamma-Linolenic Acid. Diabetes Care 16(1): 8, 1993.

This was a year-old British study of 111 diabetics to whom daily doses of 480 mg. of GLA [one of the Omega-6 Essential Fatty Acids] were given. The study concluded: "Administration of GLA to patients with mild diabetic poly-neuropathy may prevent deterioration, and, in some cases, reverse the condition."

Yesterday I went in to have blood drawn for some labs my cardiologist had ordered. He made some changes in my medications last week and I'm guessing just wanted to see that those changes were doing what they were supposed to.

Today is my first follow-up with my surgeon. Actually, I'm hoping it's with Dr. Counce, but I recognize I might be seeing one of the other doctors with whom he practices. Whatever the case, I am hoping to get a clean enough bill-of-health to return to work. If he gives me the go-ahead, I'm ready to get back in the saddle a.s.a.p.

Tomorrow, even.

More than ready.

So I did some research. Before I share the results, let me try to provide a little perspective.

The current consensus is that the formula for diabetic complications is:

Diabetes + Time = Complications.

What this means is there is a much higher potential of a diabetic becoming diagnosed with one or more complications over time. Still, the evidence to date shows that excellent control of blood sugar and the maintenance of an active lifestyle go a very long way in preventing and/or slowing down the onset of diabetic complications.

It's estimated that more than 15 million Americans have Type 2 diabetes, but as many as one third of those who do – more than five million – don't know it, and therefore aren't treating it. The consequences of untreated diabetes are bad things.

Studies have shown that up to 60% of adults with diabetes have high blood pressure and nearly all have one or more lipid abnormalities, such as increased triglycerides, low HDL cholesterol, or elevated LDL cholesterol. If you have diabetes, you’re much more likely to have: coronary artery disease; vascular disease, such as atherosclerosis (hardening of the arteries) or peripheral arterial disease (PAD); a heart attack; and/or a stroke.

Diabetes can cause kidney disease (nephropathy). High levels of blood sugar make the kidneys filter too much blood. All this extra work is hard on the filters. After many years, they start to leak. Useful protein is lost in the urine. Having small amounts of protein in the urine is called microalbuminuria. When kidney disease is diagnosed early, (during microalbuminuria), several treatments may keep kidney disease from getting worse. Having larger amounts is called macroalbuminuria. When kidney disease is caught later (during macroalbuminuria), end-stage renal disease, or ESRD, usually follows. In time, the stress of overwork causes the kidneys to lose their filtering ability. Waste products then start to build up in the blood. Finally, the kidneys fail. A person with ESRD needs to have a kidney transplant or to have the blood filtered by machine (dialysis).

The longer a person has diabetes, the higher their chances of developing diabetic eye disease (retinopathy). If left untreated, diabetic retinopathy can lead to blindness. Prolonged periods of high blood sugar levels cause damage to the small blood vessels in the retina at the back of the eye. These blood vessels initially become leaky, and then may become blocked off. This causes hemorrhages (spots of blood) and exudates (proteins) from the blood vessels on to the retina. It may also cause swelling, known as oedema of the retina. People with diabetes are 40% more likely to suffer from glaucoma than people without diabetes. The longer someone has had diabetes, the more common glaucoma is. People with diabetes are 60% more likely to develop cataracts.

About half of all people with diabetes have some form of nerve damage. It is more common in those who have had the disease for a number of years. Nerve damage from diabetes is called diabeticneuropathy. There are various types of nerve damage. One is sensorimotor neuropathy, or peripheral neuropathy. This can cause tingling, pain, numbness, or weakness in your feet and hands. Another is called autonomic neuropathy. This type can lead to: digestive problems (nausea, vomiting, diarrhea, or constipation), problems with how well your bladder works, problems having sex, dizziness or faintness, loss of the typical warning signs of a heart attack, etc. People with diabetes can also have what is called focal neuropathy . In this kind of nerve damage, a nerve or a group of nerves is affected, causing sudden weakness or pain. It can lead to double vision, a paralysis on one side of the face called Bell's palsy, or pain in the front of the thigh or other parts of the body.

People with diabetes can develop many different foot problems. Even ordinary problems can get worse and lead to serious complications. Foot problems most often happen when there is nerve damage which results in loss of feeling in your feet. Poor blood flow or changes in the shape of your feet or toes may also cause problems. Diabetes can cause changes in the skin of your feet. At times your feet may become very dry. The skin may peel and crack. The problem is that the nerves that control the oil and moisture in your feet no longer work. Poor circulation can make your foot less able to fight infection and to heal. Diabetes causes blood vessels of the foot and leg to narrow and harden. People with diabetes are far more likely to have a foot or leg amputated than other people. The problem? Many people with diabetes have artery disease, which reduces blood flow to the feet. Also, many people with diabetes have nerve disease, which reduces sensation. Together, these problems make it easy to get ulcers and infections that may lead to amputation.

Diabetes can affect every part of the body, including the skin. As many as one third of people with diabetes will have a skin disorder caused or affected by diabetes at some time in their lives. In fact, such problems are sometimes the first sign that a person has diabetes. Some of these problems are skin conditions anyone can have, but people with diabetes get more easily. These include bacterial infections, fungal infections, and itching. Other skin problems happen mostly or only to people with diabetes. These include diabeticdermopathy, necrobiosis lipoidica diabeticorum, diabetic blisters, and eruptive xanthomatosis. Yuck.

Studies show that people with diabetes have a greater risk of depression than people without diabetes. There are no easy answers about why this is true. The stress of daily diabetes management can build. You may feel alone or set apart from your friends and family because of all this extra work. If you face diabetes complications such as nerve damage, or if you are having trouble keeping your blood sugar levels where you'd like, you may feel like you're losing control of your diabetes. Even tension between you and your doctor may make you feel frustrated and sad. Depression can get you into a vicious cycle. If you are depressed and have no energy, chances are you will find such tasks as regular blood sugar testing too much. If you feel so anxious that you can't think straight, it will be hard to keep up with a good diet. Of course, this will affect your blood sugar levels.

Still, diabetic complications can be at the very least lessened for a longer time period by paying serious attention to lifestyle. A diabetic who eats right, keeps his blood sugar in control and within accepted limits, exercises and gets proper rest can expect to have a quality of life that is much higher in terms of the pain and suffering that diabetic complications brings into the lives of diabetics who do nothing to change their lifestyle.

What begins to occur in the diabetic who starts to develop complications because of uncontrolled blood sugars over time is a life filled with the possibility of becoming an invalid, either blind, an amputee, or suffering renal failure or a heart attack.

This paints a rather grim picture if lifestyle changes are not adhered to. Research has shown that the diabetic that keeps their blood sugar within acceptable limits and follows a healthy, diabetic lifestyle that has been shown to be effective against diabetic complications stands a much better chance of not developing many of the complications their less than dedicated counterparts do.

That is what I intend to do. I have to.

During the first couple of days post-surgery, even though I did seem a bit mentally foggy (which still seems to continue to a degree, darn it!), I consciously resolved to stay positive with regard to all this new crap in my life. Already, this has proved to be not an easy promise to keep to myself, but I am convinced that giving truly my best efforts in that endeavor are crucial.

Yes, there are a heck of a lot of foods that I'm really going to miss. I'm going to miss (at least initially) the sensation of fullness that comes from eating as much as I want. I can already tell that "portion-control" is going to be something of a struggle.

What I must focus upon is that I can still enjoy cooking and eating. Many old favorite dishes and techniques are things I'm now going to have to avoid. But there remains a world of possibilities out there. I must take it as my personal challenge to find new favorite dishes, new techniques, new flavor combinations with which to reward my palate.

I can do this. I have a partner who's very open to culinary exploration. I'm a pretty darned good cook, and I love learning new things. I have considerable resources at my fingertips (i.e., in my bookcase) and know how to reach a vast wealth thereof online.

It's time to wrap up the mourning and get to work.