Autonomic neuropathy can manifest itself in many different ways. It affects the autonomic nervous system, which is the nerves that regulate the things we don’t have control over, processes like digestion, sexual response, and heart function. Not to be confused with peripheral neuropathy, the neuropathy we’re systematically taught to fear because that can lead to amputations. Maybe it’s different with the internet now, but when I was younger, information about all the heinous things that diabetes can bring wasn’t so readily available. That being the case, I didn’t learn about anything more than the basic 3, retinopathy, nephropathy and (peripheral) neuropathy until autonomic neuropathy was actually affecting me at age 24, which is how I’ve learned about far too many diabetes complications. I have had some comparatively minor digestive issues, but I’ll spare you the gory details of that today.

The primary manifestation of autonomic neuropathy that I’ve experienced is rapid heart rate. I take a beta-blocker because my heart is too fast, and the beta-blocker slows it down so it isn’t working as hard as it would otherwise. Supposedly, I’ll get more mileage out of it since I take this medication. For anyone out there who’s reading this and either isn’t managing their diabetes or is at risk for such, consider this a valid reason to manage your BG’s. I could’ve avoided this, but I’m a painfully slow learner. Seriously, you can avoid this crap.

Because I take this beta-blocker, stress tests have taken on a double meaning. If you aren’t familiar with a stress test, they hook you up to a bunch of leads to find out how your heart responds to increased activity. They put you on a treadmill, and you start out slow, but the pace increases. They can also increase the incline so you’re running fast and going uphill. They make you run until your heart reaches a certain rate, then you stop, and they monitor you to make sure you don’t drop dead. The problem is, my heart doesn’t reach that optimal rate because I have the beta-blocker pulsing through my veins, and that makes it hard to get accurate results. Not a fun time, in my humble opinion. Since I’m a klutz with an aversion to exercise, especially running, I very naturally suck at this test, and frankly, would rather have back-to-back appointments with the gynecologist and the dentist, who I dread almost as much as Kerri. Unfortunately, that hasn’t been offered as an alternative to treadmill torture.

I think I’ve taken stress tests, or at least attempted to do so on four separate occasions. One time I did the stress test, and they just stopped me when I told them I was about to die. They used what data they had even though my heart never reached the threshold. The next time I tried it, my BG went low right after I started so of course, I had to stop. All the staff involved seemed annoyed as they had gotten me all hooked up, had taken the baseline readings, etc., and then it turned out to be a waste because I barely got started. The next time I had a stress test, I had an alternative procedure done, a nuclear stress test. I don’t recall the specifics to be honest because this was maybe 4 years ago. They gave me some chemical intravenously, and took pictures using this machine that reminded me of a combination x-ray-MRI machine. The chemical is supposed to cause a physical response similar to that of exercise. That test went alright as I recall, but I think the results of that procedure are considered inferior to the standard treadmill routine.

The last time I had a stress test, it was much like the first time, but I went to a new cardiologist. I got on the treadmill, and when I told them I was about to die, they had me stop. I came back a few days later to talk to the doctor, and he said the results showed that my heart is fine, but I couldn’t believe he had enough data to be able to tell me that conclusively. I think it’s now been either two or three years since that last test, and I’m pretty sure I haven’t gotten any cards in the mail that say, “Dear Lee Ann, We’ve missed you, so stop on by before your heart stops.” I figure I’m due to get another one so I might go back to the first place I went, but I really don’t know what the best thing to do is. I don’t trust the results of any of these tests because it’s impossible to get my heart to the right rate to get the necessary data. It seems like regardless of what I do, I can’t find peace of mind on this issue.

Because of all this, when I come across news like Diabetic Women More Likely to Die After Heart Attack, I’m instantly in freak-out mode. The logical part of me knows better than to read about one study and jump to conclusions, but the illogical part of me, which often has a slight advantage over the logical part, is in a state of out-right fear. There are already so many scary things about diabetes, and I try to filter it out or dilute it as best as I can, but it’s hard to push aside that information and the feelings it can evoke on a consistent basis. Sometimes, some of it, especially on the topics that are scariest to each of us, makes it past the mental barricade, panic ensues and the floodgates open.

I then start to lose my sense of what’s rational or not. While it feels like the anxiety is irrational, the fact is we’re obviously at risk for various problems, cardiovascular issues included. My heart is already affected by neuropathy so I’m not exactly a step ahead of that game, and articles like the one cited don’t offer any reassurance. It’s possible I’d be better off if I didn’t read articles like that, but how realistic is that? As counter-intuitive as it might seem, it makes me wonder if it’s the optimist, so facilely able to filter out the doom-and-gloom thoughts, who’s really the irrational one. I don’t know what the answer is, or if there is one, but I know diabetes can be as much a subjective mind game as it is objective number-crunching, weighing and measuring, and I often feel like the former is far more work than the latter.