Had my first dilated eye exam in 1981 – almost 20 years after being diagnosed at age 9 and a life time of inaccurate urine testing and an inconsistent course of one or two shots of NPH or Lente insulin a day. I had background retinopathy that was edging toward being proliferative, and since I wanted to get pregnant, the endo team I was seeing advised me to get my eyes treated NOW (then) and work toward getting my BG stabilized using CHO counting, MDI and home BG monitoring. In 1981-82 had a series of lasers in both eyes, and was sent to The Diabetes Self-Care Program in NYC where I really learned to live with my diabetes by counting carbs, monitoring my BGs and doing my best to avoid rollercoaster episodes of hypo/hyperglycemia. It was the early days home glucose monitoring with an Ames glucometer. Up to that point I had no idea what my BG were doing.

My eyes stabilized with the laser treatments in 1982 and have been quiet ever since with no further retinopathy. Eventually over the course of time, I developed frozen shoulder in my mid-30s, overt symptoms of peripheral neuropathy in my hands and feet in my mid-40s, and pronounced osteopenia leading to stress fractures and Charcot osteo-arthropathy changes in my feet in my early 50s.

Nobody ever mentioned or talked about any of these subtle or progressive neuropathic changes in my hands and feet until they were quite advanced and had been mislabeled and misdiagnosed by several MDs that I consulted. Finally an astute orthopedic physician performed an MRI and determined that I had early stages of Charcot osteo-arthropathy in my R foot and I was able to receive appropriate treatment to keep it from progressing. His excuse for the months of misdiagnosis on behalf of his colleagues was, “We aren’t used to seeing it this early”, and he relayed that usually they see a Charcot foot that looks like a swollen football with collapsed boney deformities and open ulcers. That was not what my foot looked like – originally I was diagnosed with sprain/strain injury and tendonitis, and over a period of four months my foot was not healing the way it needed to heal. Long story short, once the problem was properly diagnosed for what it was, appropriate treatment and preventive care was initiated and my foot healed, albeit with some residual deformity. I now wear sensible shoes with custom inserts and my feet are healthy and functional.

The comorbid conditions that can happen over a lifetime with T1D are insidious and progressive. They can occur at any time and are often missed or mistaken for something else. For example, it’s not about getting a gangrene infected toe or foot from a blister – more likely the ligaments and boney structure in the foot of a fairly active person (like a runner, or a mailman, or a nurse, an athlete, dancer, truck driver, etc) with advanced duration diabetes has sustained a stress fracture injury and because of neuropathy does not feel the warning sign pain signals and continues to walk, run, climb stairs, do whatever they do on a daily basis.

We must all learn to pay attention to the subtle physical change warning signals in our bodies – and face the fact that we are vulnerable to challenging comorbid conditions (I hate using the word “complications” to refer to these conditions that can occur due to diabetes – I prefer to call them “comorbid challenges”).

Face it PWDs – they happen. We all live in challenged bodies. It doesn’t make you less of a person or “a bad diabetic” to have retinopathy, or neuropathy, or progressive kidney changes, or Charcot feet. You have not failed and it is not the end of the world. Our bodies age and fall apart the more fully we live life – and we all know that living life with T1D makes us more more prone to up and down outcomes and is a super challenge for all of us. I joyfully celebrate the fact that several us have made it into our senior years having lived with T1D for 30, 40, 50, 60 plus years – and we keep on truckin’.

Thank you for taking the time to read this “diatribe”. Hopefully these words will serve to help someone facing comorbid challenges.