For too long, Larry Thomas looked across McLaren Lake from his hilltop home and saw no future. He heard the mournful wail of loons calling their mates—low, high, then low.
Thomas was tired, on the downward spiral of poorly controlled diabetes. He took 60 units of insulin three times a day. His A1C—an important measure of blood sugar over several months—averaged 14 percent, almost three times what is considered optimal.
He encountered mini-strokes and vision problems. An infection would take root. He thought he might die. He was almost right.
“Can you imagine 12 years and not having any hope?” he asks. His deep blue eyes moisten.
Geralyn Merkey, BSN, a certified diabetes educator for Spectrum Health Gerber Memorial, has seen many patients over the years.
The morning of Sept. 8, Merkey received a phone call from Thomas. His A1C was 7.1 percent. Blood sugar levels that once averaged 351 for several months were down to 156.
“He got emotional,” she recalled, “and broke down on the phone. So did I.”
Merkey had introduced Thomas and his wife, Brenda, to a better concept in diabetes control, much more reflective of the carbohydrates they plan to eat. In the process he learned he had to accept ownership of his uncontrolled illness, and gained the confidence to succeed.
‘Sleeping, with my eyes open’
A doctor diagnosed Thomas, 65, with type 2 diabetes in 2001, but suspected a problem earlier.
Then a trucker, he was driving a semi-truck west on I-94 out of Kalamazoo. He remembers the first half hour, then nothing until he was approaching Chicago, threading a semi on each side.
“I kind of went, ‘Man, where am I?’ I probably was sleeping, with my eyes open.”
Thomas learned of his diabetes after taking tests as he prepared to take a job with a different company. He had high blood sugar and high blood pressure. He did not get the job.
And still he did not take his diagnosis seriously. Asked what his favorite food was, Thomas’ reply is automatic. “Potato chips.” Also pizza, potatoes, lasagna, or really “anything with noodles.”
He might just as well have said, “Carbohydrates.”
This persisted until Thomas was hospitalized in March at Gerber Memorial.
Gangrene had settled into an infection. Tissue about an inch and a half deep had to be removed.
A doctor told him he was two days from death.
Thomas noticed how much his blood sugar improved under the care of nurses.
That was the turning point, his rock bottom. Merkey was there to meet him. He would have to take ownership of his poor diet. She would provide the education and tools necessary for success.
Chief among the new concepts she presented were two personalized scales that allowed Thomas to measure more precisely his insulin needs, and provide education in the process.
Before each meal, Thomas would measure his blood sugar, compare it against the first scale and learn exactly the amount of insulin correction he needed. Thomas and his wife then compared the carbohydrates planned in their meal, and how much correction he would need for that.
Combined, the results would tell him how many units of insulin were needed, avoiding the sugar spikes and crashes many diabetics suffer.
“It’s very much like closing the barn door after the horse ran away,” Merkey said of Thomas’ former sliding scale of glucose control. “You sit down to eat, your blood sugar is too high, you correct it, then start eating, which jacks up your system again.”
Slowly at first, Thomas was educated on carbohydrates, helping him pay better attention to his diet. His wife was key, delving into medical literature, helping him make better food choices.
“All of a sudden it was like everything clicked. I flipped out,” he said as both fists pounded the table, demonstrating his eureka moment.
After his annual September physical showed the dramatic drop in blood sugar, he called Merkey.
“She told me it was the happiest day in her life,” Thomas said.
“I would say that he is probably the most dramatic standout patient I have had in diabetes in terms of self-management,” agrees Merkey, a nurse for 30 years, the past 10 in diabetes education. “He knows he wasn’t perfect and he wasn’t doing very well. But he is willing to make himself vulnerable.”
Thomas sometimes gestures as he talks. His wife of 26 years is to his left. There is no wedding ring on his right finger; Brenda’s is also unadorned.
“We believe when you are married, it’s not your wedding ring that matters,” Thomas said. “It is the commitment of our heart.”
And now he knows it also requires commitment to himself.