Just when you think you have it all figured out

I have been living with Type 1 diabetes for 65 yrs now. I will turn 73 in one week. I have felt for some time now that I was pretty safe from anything more going wrong with my body. I needed two heart stents 14 yrs ago, and those were certainly a big surprise. I eat very well, I have have only had non diabetic Alc’s in almost 20 yrs. I exercise, I am not overweight. I am almost always at least 90% in range. My SID rate has been as low as 13, but is usually in the 20’s. I try to stay no lower than 65 and no higher than 140. I try but am not always successful.

Last week while riding my exercise bike my left leg started cramping so I started taking more magnesium. It didn’t help and soon I noticed the cramping when walking, dancing, or doing almost anything active.

I started googling and came upon Intermittent Claudication. So this means that my circulation in my right leg is bad. I went to my internist and he tested my feet. I have always had full feeling in my feet, but now I don’t. I will get a doppler ultrasound to find out how much of my leg is compromised. I will then probably be sent to a vascular surgeon.

I had an echocardiogram last week and the technician said that my heart looks great. I read the medical report on line and what I could understand sounds good. I will see the cardiologist on the 1st of Feb. I have worked so hard keeping my LDL down and my heart healthy, that I never thought much about the circulation in the rest of my body. Of course the first line of treatment is statins which I can not take because they give me neuropathy.

Frankly I am shocked and feel like Diabetes is just the disease that keeps on giving. Hopefully I can just roll with the punches for a few more years.

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Not belittling your pain, but diabetes, like many aspects of life, particularly aging, is one where you plan for the worst, but hope for the best.

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Very true James, but I also believe that really hard work should pay off or why do it? Unless you enjoy the work and then the hard work itself is the reward. I can’t say that I particularly enjoy this work.

Good to see you James, you haven’t posted in a while.Hope that all is well with you.

Marilyn, feeling discouraged at this news is certainly understandable. I encourage you to do what you have done many times for yourself and your family. Learn all you can about this recent setback, select an appropriate course of action, then update your plan if/when necessary.

I share your weariness of the long diabetes struggle! Don’t let it deprive you of the favorable attributes on your side.

There may be more hope in your circumstance than you perceive at the moment. I wish you the best. Don’t count yourself out!

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Thanks so much Terry. I think that because my family has had to deal with so many medical problems, sometimes one more just seems like too much. I know from experience that I will deal with this one well, once I find out more about it. I know that you understand from experience.

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@Marilyn6 - Don’t feel too bad, there’s nothing long term diabetics can do about peripheral artery disease. Over the past year I suffered a heart attack, followed by triple bypass and kidney failure. My coronary artery disease was caused by severe calcification of not only my coronary arteries but also all my peripheral arteries. Following my surgery I had some pretty nasty open wounds on my lower legs and feet, and spent over 2 months in hospital.

Once discharged, the wounds wouldn’t heal and I finally saw a vascular surgeon, who diagnosed me with acute limb ischemia. They opened up 2 of the 3 blockages in one leg with angioplasty, after which the wounds have finally healed.

Signs of acute limb ischemia are claudication, loss of all hair on lower legs, slow or non healing wounds on legs / feet / toes, and intense pain nerve pain when you elevate your legs (at night), which can only be resolved by hanging you legs over the side of the beds.

Statins aren’t going to reverse the calcification once you have it, the only treatment is angioplasty and or bypass surgery. You might also ask for some strong pain killers, I’m using hydromorphone

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Oh Jim, you have really been through a great deal, I had no idea. How are you feeling now?
I will get more information next week after having a Doppler ultrasound of my legs. I also have my yearly appointment with my cardiologist.

I am not in pain except when exercising and sometimes my leg doesn’t bother me at all.
I will post more as I learn what my situation is.

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imo You are doing great at managing diabetes. The fact that the average life expectancy is 77 years and at 73 years have no sign of heart disease, the largest risk, means you are doing better than the average person who doesn’t have diabetes. I’m only a few years older and wish I’d been able to do as well as you have for as long.

It sounds like you should already be seeing a vascular specialist. Your symptoms are like what my non-diabetic brother has, DVT. He’s been healthy and athletic -and his LDL was low. His diagnosis and effective treatment was delayed by months waiting to get referred to the right kind of doctor. They eventually started him on a blood thinner.

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Thanks so much, but I did receive two heart stents 14 yrs ago, although I didn’t have a heart attack. I have been working hard to keep my heart healthy, so I will be thrilled if my cardiologist agrees with the tech who did my echocardiogram the other day.

My eyes and kidneys are great and I thought I might make it to 80+. Since I am getting the Doppler ultrasound on Monday and seeing my cardiologist the next Monday, I hope that I will get some answers then and a plan for a way forward. I only take a baby aspirin so I imagine that I could take a stronger blood thinner. I don’t like the idea of getting more stents, but I realize that it is doable.

I hope that your brother is doing well.

Marilyn

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I had a Doppler about 5 years ago on my legs. It wasn’t a big ordeal. I was waking up with leg cramps every night. Ouch. The cardiologist found that my circulation in my left leg was compromised by a leaking vessel. I wore lovely compression stockings to my hips everyday, in summer, in humid Arkansas until I could come to grips with the decision to have vein ablation. I am glad I did and won’t hesitate should I need to do it on the other leg.

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Well my results were not good. I had the Doppler ultrasound this morning and my internist called me this evening. He also called a vascular surgeon who will fit me into his schedule. Everything that is listed to do so that you won’t have this problem, I have already been doing for years. Statins of course are recommended but I cannot take them. Tomorrow my results should be posted and I will try to read the report.

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Marilyn I would think all the good things you are doing for your heart should benefit your other areas too, so this is confusing to me. My total cholesterol is a little on the high side (219) and my endo wants me to go on a statin. I have taken a low 20 mg dose every other day on and off over the last 4 years. I have been off for a year. I read the book The Great Cholesterol Myth, written by a cardiologist and a nutritionist with a PHD. It really is a good read and goes into detail how big pharma has pushed statins on all of us. According to these Dr half of the people who have heart attacks have high cholesterol and half have normal cholesterol. They believe your triglycerides divided by your HDL should be 2 or under and is a better indicator of risk. They also believe statins do more harm then good for the majority of people. My endo ordered a CT scan of the heart for me (at my insistence and I paid $130 for it since insurance will not cover it) and my Agatston score was 0. She said it was incredible that a 65 year old diabetic would be 0. She backed off on the statin.

Have you ever had a Life Line Screening? They come to communities every 3 months or so and screen for carotid artery disease, peripheral artery disease, and abdominal aortic aneurysms. The cost on this is $150. I do get leg cramps a lot, even though my peripheral artery screening came out normal. Other than determining your total cholesterol and your blood pressure, I think it is sad that the medical community waits until someone has a stroke or heart attack and then runs a bunch of tests.

My A1c score is typically around 6.4, but I have only been diabetic for 9 years. I suspect your issues are from a lifetime of being diabetic. Keep up your great work and keep us posted please.

Hi Maggie, I have spent years reading about the pros and cons of taking a statin. I now am firmly in the camp that thinks that they are helpful for some people. I really wish I could take them.

I received two heart stents after 50 yrs of living with diabetes and now I imagine leg stents at my 65th year of having diabetes.

My total Cholesterol is 171
LDL 84
Trigs 54
HDL 68

The last time I had a doctor check my feet was about 3 yrs ago and they were almost perfect, so I was not worried about them.

I am really shocked that this has happened.
I live in a small college town and have never heard of Life Line Screening coming here. Most of their screenings are done by my doctors but not all.

You were wise to get your heart checked out and receiving a zero score is great.

Your cholesterol numbers are great without the statins, so why would you want to take them? These awesome numbers basically confirm (in my eyes) that 50% of the people with heart issues have normal lipid levels. I really am not sure what you could have done differently.
Stay well!

Maggie, I work really hard to have those numbers. My cardiologist would like my LDL to be much lower. I heard someone on line, whom trust, say that when a person has a heart attack their numbers immediately fall. If their blood isn’t looked at until after the heart attack the cholesterol numbers have probably fallen to a normal reading and are not accurate.

I read the report and it isn’t at all good. I have problems with both legs but the right one is worse with a 78% closure.

I just don’t know what else I could have done to prevent this. Atherosclerosis is hard to control. I don’t think either of my parents had this certainly not my father.

What a birthday surprise.

Do be careful how you treat this. There is a medical scam/industry providing surgery to people that don’t need it. There are non-invasive first steps that need to be considered first.

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James, thanks for posting this article. It is very eye opening to say the least.
I had my annual cardiologist appointment this morning. He said that my heart looks great almost normal, so I guess all of my hard work is paying off.

This physician looked at the report on my legs and said that he didn’t think they were too bad. He is also impressed that I have never had wounds on my feet. He wants me to see a vascular surgeon he has worked with, because he thinks that the local surgeon uses way too many stents at least in his opinion.

The cardiologist ordered another test which uses dye to get an even better look at my legs. He doesn’t feel that my legs are an emergency situation, and that I may not even need stents.
I have worked with this cardiologist for over 10 years, and I have a lot of faith in him.
So that was good news.

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Marilyn, it is always good to have a doctor you trust! Your cardiologist knows you (and your community doctors!) and can look at “abnormal” tests with a clear eye. I’m a retired nurse who gets flustered when I get an abnormal lab test, until I speak with a trusted physician who reminds me that my normal and your normal aren’t necessarily within the printed range when you see the results. Kinda like thinking everyone’s normal temperature is always 98.6.

Good luck as your adventure continues!

Thanks Ms_Mody, My cardiologist’s assistant just called me and said that the doctor thought the pictures of my legs were quite unusual, but not an emergency. The assistant is sending my file to a vascular surgeon in a large city about 11/2 hrs away and she is writing urgent on the file. If I do need stents, I want to get the procedure over with. At this point I don’t have full use of my right leg.