John Watson walked into his optometrist’s office expecting to leave with a new eyeglass prescription but walked out instead with an ultimatum: no new prescription until he was tested for diabetes.
“I laughed and said ‘I don’t have diabetes, I’m just going blind,’” said Watson.
Risk factors for type 2 diabetes, which affects more than 29 million Americans, are varied, ranging from genetics (a family history) to lifestyle (too much food, not enough exercise).
Watson’s blood sugar was at 300 milligrams per deciliter (mg/dL). For the average person, normal glucose levels are under 100 mg/dL when fasting and less than 140 two hours after eating. Other symptoms of diabetes are harder to pin down: frequent urination, feeling very hungry, thirsty or tired, weight loss, cuts and bruises that heal slowly, tingling or numbness in hands or feet or blurry vision.
Watson assumed his vision problems were a sign of advancing age, not a symptom of diabetes.
He blames his condition on too many apple pies and cheeseburgers. When diagnosed he weighed 270 pounds.
With the help of physicians, Watson controlled his blood sugar levels with diet and exercise. When his blood sugar levels dropped to 103 mg/dL— just three points above the normal marker — he decided to continue management of the disease on his own without medications. That’s when things got out of control.
Type 2 diabetes typically begins with insulin resistance, when the body doesn't use insulin effectively to regulate blood glucose levels. To make up for higher than normal blood sugar levels, the pancreas produces more insulin to further lower blood glucose. Over time, the pancreas loses the ability to make sufficient insulin to keep up with the body's increased insulin needs. As a result, blood glucose levels increase.
“Two years ago I collapsed while at a diabetes event—of all places!” said Watson. “My sugar was 511. I was almost in a diabetic coma. I had lost weight. I was weighing 210 pounds but that wasn’t enough. Diet and exercise were no longer working. It’s only one part of the formula.”
At that moment Watson decided to return to the care of a medical team. As an Army veteran, Watson sought help from Veterans Affairs San Diego Healthcare System. His physicians helped get him back on track and suggested that he participate in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) Study, a long-term study of different treatments for type 2 diabetes in partnership with UC San Diego Health.
Funded by the National Institutes of Health, GRADE researchers hope to determine which of four widely used diabetes drugs in combination with metformin, the most common first-line medication for treating type 2 diabetes, is most effective when metformin alone is no longer enough to control glucose levels, said Edward Chao, DO, associate clinical professor of medicine at UC San Diego School of Medicine and one of the junior investigators on the study working with principal investigator, Robert Henry, MD, chief of the Section of Endocrinology, Metabolism & Diabetes at VA San Diego Healthcare System.
“This is an important practical study because it will help clinicians best optimize treatment and personalize care for type 2 diabetes patients,” said Chao. “Patients who participate in the GRADE study tend to do better with diabetes control because they have follow up visits with their healthcare team and there is more control over the medications.”
Participants in the study are not required to have medical insurance. All medical visits associated with this study, as well as medications and supplies, are provided at no cost. Patients receive diabetes education and four office visits for up to seven years.
San Diego is one of only three sites on the West Coast to offer this study. It is open to anyone who meets study qualifications, which include a diagnosis of type 2 diabetes within the past 10 years and are age 30 or older.
“The GRADE study was the missing piece that I was looking for,” said Watson. “There’s a support team of doctors and caregivers that help me when I’m up or down. The one thing they give me is hope. Not that one day I’ll be cured but that I can fight this. By taking some steps to take care of myself after abusing myself for so many years, I can fight this. It’s not just the medicine.”
Exercise and dieting doesn’t compare to consequences with allowing the disease to get out of control again, he said. Watson now sits on a local American Diabetes Association committee to help create awareness about the disease and how to live with it. He’s seen and spoken to people who don’t follow a health or treatment plan and the damage it can do. His own friend had both legs amputated from the knees down as a complication of diabetes.
Watson committed to taking his disease seriously and took up cycling to help him lose weight. He now weighs 190 pounds and has his blood sugar under control. He credits the friendships he’s built through a local cycling club, 619 Barkada (Tagalog for “friend”), for keeping him motivated and engaged. His 24-year-old son, Joshua, also supports him by riding with his father on 60- and 70-mile bike rides along the San Diego coast.
“It’s a major part of my project – I call diabetes a project,” said Watson. “I know if I don’t continue exercising it’s going to come back. Cycling is my thing but everyone can find something they enjoy. Everyone has excuses. What can you do? Start there. Just don’t give up.”
For more information or to determine study qualifications for this study, call Catherine DeLue at 858-552-8585, extension 6740 or Elsa Diaz and Gaby Armijo at 858-552-858, extension 1431.
Care at UC San Diego Health