Do You Have the Bad Kind of Diabetes and Arthritis?
I hate the question. It comes to me in different forms these days, and I bristle each time I hear it. The question refers to what kind of arthritis or diabetes I have. Do I have the bad kind? Well, do you know a good kind of diabetes or arthritis to have?
Managing multiple chronic conditions
So I always ask, "What are you asking me?" Are you asking if I have osteoarthritis, you know the kind that gets progressively worse and accounts for the majority of knee replacements in the US?1 Yes, I have that. Or do you mean rheumatoid arthritis (RA), which causes between 20% and 30% disability among those who have the condition?2 Yeah, I have that. Or maybe you mean diabetes, which causes “diabetic retinopathy and is the most frequent cause of new cases of blindness among adults aged 20–74 years” in the United States?3 Yeah, I have that.
There are no good kinds
My point is I do not know any good diabetes or arthritis. In both conditions, we have multiple paths to the same door, which is suffering and hardship. Responding like that usually sends the casual questioner away with a perplexed look on their face. I love it.
Chronic conditions present different hardships
The fact is that when you toss in ankylosing spondylitis (AS), my doctor says I am a primordial soup of conditions and causes. But I am not alone. Many people in our community have multiple diagnoses and guess what? Each impacts the other in not so lovely ways.
RA inflammation affects my blood sugar
For instance, having diabetes means that when inflammation is high, my blood sugar is difficult to manage. I get wild swings and my numbers (we in the diabetes community live by the numbers) - my A1C, day-to-day blood sugars, and cholesterol - can be wildly out of control. If we are talking about a full-on flare well, that pushes numbers into unimaginable areas.
High blood sugar makes my RA worse
But here is a secret. If I have high blood sugar, RA becomes so much worse. I am more susceptible to flares, I am more tired, and I feel awful. So how do I treat high blood sugar? It is that primordial soup thing. Sometimes it is just a matter of how you look at it when it comes to first-line treatment.
Seeking care with multiple chronic conditions
If I feel the flare caused the issues, I call my rheumatologist. But unfortunately, his main offering to deal with a flare is a month-long course of oral steroids. I say, which is unfortunate because steroids create havoc with diabetes. So I seldom make that call.
If I think the cause is that my blood sugar is out of control, I call my endocrinologist. He will increase my insulin intake, change my pump patterns, and attack it full-on in an attempt to lower my blood sugar. Making these changes can lead to hypoglycemia, and if you want to rock RA, get a few incidents of hypoglycemia. You become afraid to leave the house or even your chair, and that lack of exercise has a huge impact on joint pain.
Staying on track with my conditions
So how do I keep things on track in a body filled with traps that interact with each other? First, I have to give myself some grace. Yes, my diabetes is managed today, but sometimes blood sugar is just awful. In those times, I have to remember that I am not my numbers, and those numbers are not a judgment on me.
My numbers are not a judgment on me
Blood sugar numbers are simply information. Information I need to manage diabetes, but they do not indicate my worth. Like the sed rate is only a number. True, I need that number to tell if I am still on track with RA treatment. But good or bad, my sed rate does not indicate what kind of person I am.
Also, for the record, sometimes I can do everything right and end up with terrible numbers. But no numbers - be they diabetes, RA, or AS - define me. I remember that, like many people in our community, I have multiple conditions. But none of us should let those conditions have us.
On a scale of 1(low) to 5(high), how difficult is it for you to talk about having RA?