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Sugar, Sugar: Living and ranching with diabetes

Jan Swan Wood was exhausted all the time. No matter how much sleep she got, she was still tired. The rancher, cartoonist and columnist from Newell, S.D., could hardly stay awake while driving or working around the ranch. She felt slightly nauseous all the time and couldn’t focus on even simple tasks.

A friend finally badgered her into seeing a doctor, who ordered a full blood panel and identified the culprit — type 2 diabetes.

The human body uses carbohydrates to make energy. The pancreas produces a hormone called insulin, which makes the carbohydrates usable. When the body’s ability to produce or respond to insulin is impaired, abnormal metabolism of carbohydrates and elevated levels of the sugar glucose in the blood can result in diabetes.

There are three types of diabetes: type 1, type 2 and gestational. Gestational diabetes is brought on by pregnancy and the resulting changes in a woman’s body. Type 1 is when the body produces little or no insulin. Symptoms usually appear quickly, within days or a few weeks. Type 2 is when the body does not respond normally to insulin. It is the most common and the warning signs can be very mild. In fact, one out of four people with diabetes doesn’t know they have it.

There is no cure for diabetes, so it must be managed through medication and diet.

Frequent or ongoing high blood sugar — one of the most serious problems for diabetics — can cause damage to nerves, blood vessels and organs. It can lead to other serious conditions such as a build up of acids in the blood called ketoacidosis. Type 2 diabetes can cause extremely high blood sugar and lead to a deadly condition where the body cannot process sugar.

“I’m sure I had it for quite a while before being diagnosed,” Swan Wood said. “It’s a roller coaster to manage. My pancreas makes insulin, but my body can’t use it, so that’s what I take the medication for. One of these days, my pancreas will just quit, then I’ll have to take insulin and the medicine to make my body use it.”

Warning signs

Early signs of diabetes are increased thirst, headaches, trouble concentrating, blurred vision, frequent urination, fatigue and weight loss. These signs appear when a blood sugar level is approaching 180 milligrams per deciliter (mg/dL) or higher, but it’s different for everyone.

Swan Wood wasn’t overweight, but she lost 10 pounds as she dealt with the diabetes and medication, trying to learn how to manage her new lifestyle.

“The first medicine I took was Metformin. It worked fantastic, until I went septic.”

In 2015, she had shoulder and hand surgery.

After the surgery Swan Wood was hospitalized due to complications from what doctors suspected was the oral medication. She became septic. Sepsis is a severe infection, which often results in death.

Eight weeks after the surgery Swan Wood’s blood sugar was still not regulated on the new medication. She resumed drawing, but had no recollection of it.

“When the medicine got straightened out, I found six weeks of cartoons I didn’t recognize. I didn’t remember drawing them at all.”

She’s been through several medicines, with varying levels of success.

“One of the more recent medicines I took was made from lizard saliva, That’s how they kill their prey, the saliva is toxic and makes their prey hemorrhage.

“My son got a kick out of that. Medicine made from lizard spit. Take something that makes me sick to make me better. The side effects were terrible. My eyes and nose watered all the time. I didn’t know if I had a cold or hay fever. I couldn’t keep my eyes and nose wiped.”

Management of the medication has been a nightmare since then.”

She’s now on Metformin again, and it’s working. “I feel normal for the first time in two and a half years,” she said.

Just being diagnosed and given medicine won’t manage diabetes.

“I have a friend who was diagnosed,” Swan Wood said, “they gave him some medicine and sent him on his way.

“When I talked to him, he said this is not working.” The symptoms were still hanging on, and the cowboy was having trouble keeping up with ranch work.

“Medicine by itself is not enough,” Swan Wood said. “You have to manage your diet. So I went to his kitchen and we went through all the food in his refrigerator and pantry and he told me to sort out everything that was bad.

“He didn’t have much left when I was done. Now he reads labels. He calls me from the grocery store and asks, ‘Can I eat this?’ He’s making an effort to get himself educated and take control of his diet. It’s up to each person to take control of their diet and lifestyle. Diabetes can be managed.”

COUNTING CARBS

Eating becomes a daily counting exercise for diabetics. Carbohydrates, which contain sugars the body uses, are the key because it affects blood sugar levels faster than protein or fat. Foods are full of carbohydrates. Some of the most loaded ones are sweets, fruit, milk, yogurt, bread, cereal, rice, pasta and potatoes. Diabetics must count carbohydrates and split them evenly among meals to match the available insulin, which may or may not come from the body.

“Go to the salebarn cafe and try to find something on the menu you can eat. No potatoes or bread. And corn — if I’m gonna eat corn, I might as well eat a handful of M&Ms. They look at me funny when I order a hamburger with no bun. You can kind of manage eating at home, but eating out is a challenge,” Swan Wood said.

“The diet’s not bad at home. I just make stuff I can eat. You do get sick of grilled chicken salads. I eat a lot of lean meat. I deer hunt, so I eat a lot of that.”

Swan Wood also has adapted many of her favorite recipes to her dietary requirements, making whole-wheat breads and scones.

“At least then I know what’s in it,” she said. “You have to realize fat content affects insulin. Cheese is a good protein, but it’s high in fat. Eggs are good protein. I eat a lot of eggs.

“Everyone’s different on what sets them off. Corn and beans are trigger foods for me.”

Swan Wood has a diabetes counselor who urged her to have a free day and eat some things she normally wouldn’t. She picked Sunday because that was a day she might go out to eat. Monday morning her sugar is high, but she gets back on the routine.

“I try to keep carbs under 40 grams per meal,” Swan Wood said. “The learning curve is tremendous. For breakfast I may have one slice of whole wheat or sourdough toast, two eggs and some lean meat. I don’t eat bacon.”

If more carbohydrates are eaten than the available insulin can process, blood sugar goes up. Eating too few carbohydrates will cause blood sugar to fall too low. Many aids are available to help diabetics count carbs, including food exchange lists.

Carbs cannot be cut out of the diet, but diabetics must balance them with protein, fiber and healthy fat.

“Working outside is hard, too. If my blood sugar gets too high, I can’t think. If it gets too low, I pass out. It causes heart palpitations. If you’re setting an H brace by yourself and one of those happens, it can be dangerous. So I have to carry all this stuff around. If my sugar gets too low I can drink Powerade, but it’s so full of sugar, I have to eat some protein to counteract it. You’ve got to be ready to deal with whatever your body throws at you.”

NERVE DAMAGE

Like most diabetics, Swan Wood deals with some pain associated with nerve damage. Her feet feel hot and as the day progresses, it gets worse. “It feels like they’re in molten lava with a slight electrical charge. Soaking them in ice water feels good, but they still hurt.

“If I go somewhere and am coming home in the truck at night, I will have to stop and take my boots and socks off. I can’t stand anything on my feet any longer.”

When her blood sugar is in balance it’s not as bad.

While her feet have this sensation to some level nearly all the time, they also aren’t sensitive to external pain, so she has to check them every morning and evening to make sure they weren’t injured without her knowing it. She tells of one time she thought she had a little rock in her sock, but when she took her sock off she found out there was a staple in her foot.

Another drawback to ranching with diabetes is the healing process is very slow. Sometimes wounds won’t heal, especially on the feet of diabetics. Gangrene can set in and the limb be lost. Since small wounds happen all the time working outside, this can turn into big problems for a diabetic rancher.

Swan Wood said she’s learned that there’s no one-size-fits all answer for diabetes.

“Get educated. Don’t just take the bottle of pills from the pharmacy and think you’ve got it fixed. It’s your responsibility, not your doctor’s, to manage your health.” ❖

Out of joint: Managing joint injury and pain

Say a horse fell with you when you were 19. Or a cow got you down when you were 35. Or maybe you just use your knees and shoulders all day, every day and they’re starting to protest.

The question is, should you just keep gritting your teeth and put up with it, or is there something someone can do to make everyday life with your joints a little less painful?

Medical technology helps many people with a variety of orthopedic concerns from knees to shoulders to hips. However, orthopedic surgeon Whitney Robinson, MD, said before using new technologies, it’s essential to have a good idea of the injury or problem, along with the reality of what can be accomplished.

“For example, the knee. There is a lot of talk about cartilage repair in the knee,” said the Billings Clinic orthopedic surgeon. “There are actually two parts of the knee we call cartilage, so it can get confusing. One of these cartilages is the meniscus, in which we often see tears in active young people. The surface of the joint is also referred to as cartilage. We can distinguish between the two by calling one the articular joint cartilage and the other, the surface of the joint. Articular cartilage can be damaged in a variety of ways. However, the one that wears away at the surface of the joint can often be routine osteoarthritis or rheumatoid arthritis. Both are inflammatory and both wear away at the surface of the joint.”

Robinson explained knee potholes, too.

“When people damage a joint through an injury, they might get a ding in the surface of the joint. We call this a pothole. We have a number of different options for potholes, and although none work spectacularly well, we can fix those. Keep in mind an injury is very different than the joint wearing away.”

Farmers and ranchers will show up at the doctor when there is a definite problem. “I’ve been at the Billings Clinic for 25 years and I know when a rancher shows up and says his knee hurts, it hurts. I see ranchers and farmers who are 58 years old have arthritis,” Robinson said. “Other than doing a joint replacement, there is not a lot I can do to replace cartilage for them. I can’t paint on a new surface of the joint. I can’t inject magic stem cells.”

STEM CELLS

Robinson said there is zero data on the efficacy of isolating stem cells and injecting them into joints, which is a new procedure being tried in some places.

“I’m not opposed to technology, but I haven’t seen that stem cell procedure actually work. I know it doesn’t regrow the surface of the joint. Could it be that someday we will have true stem cells that can become cartilage cells and glue on? Maybe. Currently they are making what are called protein scaffolds. Doctors take a piece of cartilage from your knee, a medical company grows that in a lab and mixes it with a scaffold that’s used to replace the pothole. We can make that work, but it doesn’t make the joint healthy enough for someone to go back into active sports. There are disks to potentially fill potholes, but at this point, those are experimental.”

For ranchers, a pothole in a knee might occur when they fall off a horse, resulting in a tear of the meniscus and a divot in the surface of the joint, which can be cleaned up.

“We will first try what’s called a microfracture. What you do is poke the base of the pothole, which causes bleeding. The bleeding fills the pothole and then that blood turns to scar tissues which then becomes something that approximates the surface of the joint.”

“Microfractures have limitations, but that’s the primary repair we will try first,” Robinson said. “But again, remember that we can do repairs to injuries — potholes can be filled up — but for the shoulder, knees and hip the algorithms are the same. When the joint gets worn away, it has to be replaced with metal and plastic.”

The bad news? “There is not a lot I can do to slow down the progression of arthritis. We can try to make you feel better, but the process continues. Sure, you can inject a joint with hyaluronic acid, but that only provides relief short term. It doesn’t regrow cartilage and it doesn’t make arthritis disappear. It really won’t change the natural process.”

He pointed out knee replacement is the third most common surgery in the U.S.

“In general, knee replacements work pretty well. Your knee won’t be as good as you once had, and you probably won’t be playing basketball, but a knee replacement will let you get back to doing stuff. Ranchers develop what we call medial compartment arthritis, which is arthritis on the side of the knee. They are bowlegged. Ranchers generally have crooked knees, so we can straighten out those legs and get them back to riding horses and doing their work. Technology with knee replacement has been good.”

As for prevention, Robinson’s advice is don’t gain excessive weight. “There is a strong correlation between body size and arthritis. The other advice is don’t get injured. If you injure your knee jumping off a horse at the rodeo and hurt something, that will lead to arthritis. Don’t get fat and don’t get injured is the best advice I can give for avoiding arthritis.”

The surgeon said there can be some relief with activity modification, but ranchers aren’t big on going to the gym. Physical therapy may help, although it doesn’t really make arthritis pain less. “There is not a lot of data that naturopathic medicine works, either. Once the arthritis process gets going, there is not a lot you can do. Sometimes we can go in and clean up arthritic knees, but that’s about it,” he said.

Robinson reiterated that using technologies like a scaffold — that is meant to be combined with cartilage cells and reproduced in labs — can sometimes be used to fix potholes caused by an injury, but not arthritis. “These new technologies are super expensive. I’m not a rapid embracer of technology, and I’ve seen a number of treatments and technologies come and go. Many products are rapidly promoted and get a lot of hype. That doesn’t mean they work. Steer clear of ‘miracle cures,’” he cautioned. “However there have been real improvements in existing products such as an improvement in plastic for replacements. Now a new joint can last 20-25 years.” ❖