Jan 30

Jan 30 As fun as hot pokers being shoved in our eyes.

Diabetic retinopathy. It's not fun, and for a long time Marshall was embarrassed. When you've had diabetes as long as Marshall has (coming up on 28 years!) you're bound to have a few complications, and this is the worst and scariest we've come up against. Nearly 11 years ago his eye doctor referred him to a "Retina and Vitreous" specialist. The retina is the clear, light sensitive membrane at the back of the eye, and the vitreous is the clear matter between the retina and the lens (is high school A&P coming back to you now?). Diabetic retinopathy is when prolonged high blood sugars cause damage to the blood vessels of the retina. The vessels can swell and leak, or they can close off stopping blood from passing through. High blood sugar can also lead to abnormal vessel growth. If left untreated, all these issues will result in vision loss.

Back in the 90s, when Marshall was 16 and newly diagnosed, things were a lot different. Marshall took 2 shots a day, one in the morning and one at night, and he had to mix the insulin (Regular&NPH). The doctors told him not to eat sugar and maintain a daily routine. This meant that Marshall, an athletic and outgoing high school boy, was supposed to sleep the same amount every night, eat roughly the same thing every day at the same time everyday, and maintain the same level of physical activity every day. Oh, and don't eat sugar, because back then it was all about the sugar. The insulin dictated his life, rather than the other way around. Can you imagine?! And this was even light years better than his dad and my aunt had it back in the 60s and 70s. But it still wasn't great and it was hard for anyone, especially a 16 year old boy, to achieve. Things are so much better now, in so many ways. But the guilt and embarrassment lingers for Marshall. Intellectually he knows he did the best he could with the tools he was provided and the place he was in, but every time he gets blurry vision or a floater in his eye he beats himself up a little bit. It makes me sad, but I'm so happy he's able to do something about it now.

Eleven years ago feels like a lifetime: we were still a childless couple, Marshall was still on MDI (Multi Daily Injections), and his eyesight was failing him. I went with him to his first appointment with Dr.Mehta, which happened to be only a block from our house in Denver. As we sat in the waiting room I looked around at the others sitting in the chairs and saw that we were the youngest in the room by well over 40 years. Years of higher blood sugars and A1cs had aged Marshall's eyes to that of a 70 year old. After the doctor took us back to the examination room he took a look in Marshall's eyes. He rattled something off about diabetic retinopathy, vitreous clouding, blood vessel crowding, and the need for immediate laser surgery. He seemed quite certain that this was the only option, and if we waited much longer there was the very real risk that Marshall could loose his sight. He explained that he would fire 600-800 pulses of laser into each eye, in doing so killing the new blood vessels that were growing at the back of the eye and leaking blood into the vitreous. We left the office a little stunned and with an appointment for the following week for his first round of laser.

Those first few visits were painful for Marshall and emotionally rough for both of us. We were thinking about starting our family and this slap of realism smacked us both in the face. We all feel immortal when we're in our 20s, and Marshall in particular had a "diabetes be damned" mentality; diabetes had already robbed him of too much in his life and he wasn't about to let it dictate the rest of it. This is something that many teenagers, especially boys, experience when they are diagnosed. Couple that with the medical practices not being where they are today, and it was the perfect storm for later complications. But the idea of being a dad, and the desire to care for himself in a way his dad was unable to, has turned Marshall into an amazing Type 1 role model. As important as it is for Ollie and Walker to know how to care for the medical side of Type 1 it's equally important that they understand how to navigate the emotional side. It's a balance. We need to be gentle on ourselves. Don't stick your head in the sand, but understand there are things you can control and things you can't. And all we can do is our best with the tools we have, both physical and emotional.

Marshall has had many bouts with the laser since 2005. His vision is much better, both because of the surgeries and his ability to keep his A1c at a healthier range. In 2006 he began using an insulin pump and did away with syringes. And in 2007 and 2010 we welcomed Ollie and Walker into our world. There's no better motivator for Marshall than his children.