Painless Diabetes

The trouble with diabetes is that it doesn’t hurt. Because it is painless, most people who have diabetes think that they can ignore it. After all, anything that is serious would hurt a lot, right?


The pain comes later with the complications of diabetes that come in its wake, sometimes years later. Some of these complications hurt a whole lot. Think of the continuous pain of diabetic neuropathy, one of the most common complications of diabetes. Or think of the sharp pain when you get a heart attack.

Diabetes is the most insidious disease anyone can get. A dictionary definition of insidious is one that develops “so gradually as to be well established before becoming apparent.”

When we first get diabetes, the symptoms don’t seem like much. “Often, people with type 2 diabetes have no symptoms at first,” according to the U.S. National Institutes of Health. “They may not have symptoms for many years.” That certainly rings a bell with me, because when a doctor told me in February 1994 that my A1C level was 14.4 and that I had diabetes, I had never had any symptoms of diabetes.

When people begin to realize that something is wrong, the typical symptoms of diabetes that they experience are excessive thirst and appetite, increased urination, unusual weight loss or gain, fatigue, nausea, blurred vision, dry mouth, slow-healing sores or cuts, itching skin, and yeast infections. Women may also have frequent vaginal infections.

Did you notice what’s missing from that list of symptoms? Pain. Few people would even take even one aspirin tablet for any of these common symptoms.

September is National Pain Awareness Month, and those of us with diabetes — the most insidious and potentially painful disease we can get — have to be included. The National Pain Awareness Campaign is a cooperative effort between The National Pain Foundation and the American Academy of Pain Medicine.

Even though many of us aren’t hurting now, some of us or our family and friends are in great pain because of the complications of diabetes. Sometimes these people can reverse the complications and the pain that goes with them. But sadly, it is already too late for many people.

Right now, I am thinking of those of us who aren’t in pain, at least not yet. Normally, pain can serve as a wakeup call to action. But that doesn’t work with diabetes. The pain of disease, which can be a good time, comes too late for us.

Those of us who have diabetes have to be smart enough to manage their diabetes before it hurts. Managing diabetes means that we have to constantly avoid high blood sugar. It’s that simple.

Yet the ways that we can carry out that simple mandate are awfully complex. That’s why I have written thousands of articles about diabetes with many more to come. Stay low!

This article is based on an earlier version of my article published by HealthCentral.

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  • lilline at

    i was told by my dietian in August that i would have to take my fbs when i woke up then she said I would have to take it only after lunch, then the next visit she told me that I still have to take my fbs when i wake up then alternate it every day 2 hours after breakfast, lunch and dinner to see how I am doing and I have been doing that consistenly unless, i fell asleep or could not make it for some odd reason, but I have been consistent. I called up the doctors office for my other prescripts that i was getting low on then i asked for bg test strips, I could not get them she told me, I said, the dietian told me that I must test my blood sugar, twice a day. she went to look for some there but they did not have anymore then she talked to that doctor, he told her to tell me, when you take an oral medication as Metformin, that I do NOT take a blood sugar test twice a day. I thought what a JERK, he never told me this fact he never told me anything when I was in his office. So I told the lady, my dietian told me to do this and I trust her and I am going to listen to her. She told me to go to her office and get free strips SO that is what I had to do. THIS doctor is totally incompetent, he set me up for some blood tests and the glucose TEST but I did not know what that was about never INFORMED ME OF ANYTHING so So you can NOT test a person in 2 1/2 months it is 3 MONTHS. So I cancelled it, and planning on eliminating this INCOMPETENT DOCTOR who I never liked from day one and find a GOOD AND BETTER DOCTOR. He has been bad since day one, I think I told you this , David. He stresses me out when i have to write about him. I know bad doctors when I was caring for my husband for 3 yrs I dealt with the worst doctors and I stood up to all of them and got others and they were just as bad, if they know the person is a chronic case with no chance of recovery they treat your loved one like dirt, I do not like doctors from what I have learned, sorry I say what I want to say on here.

    • David Mendosa at

      Dear Lilline,

      I think I must have written an article some time about how important it is for our doctors to be able to get along with us. We have to have rapport with our doctors. When we don’t, it’s time to switch doctors. You did the smart thing.



  • Mike Sheldrick at


    Indeed, it was 92 at 6:00 this morning. It had climbed only to the 90s after my ketogenic dining during the day, and then fell back to the 70s between meals. Before bed I had half an apple, plus cheese just because I felt like it, and the 30 gms of fiber were with my supposed consumption range of carbs for the day. I did not measure my blood glucose before bed.

    Dawn phenomenon or Somogyi effect, don’t know. And I don’t think I’m in immediate danger. Never having seen an excursion above 140. Still it’s something I definitely need to monitor and deal with.

    My larger point remains: there are vast numbers of people who are pre-diabetes, or ” pre-pre.”
    The vast amount of material available on diabetes — and treatment– doesn’t reach them until after they have it, and it is irreversible and, often, mortally dangerous. How do we reach them?

    Assume you’ve seen this article:


    • David Mendosa at

      Dear Mike,

      Thank you. I want to respond to several points in your careful message:

      1. Your level of 92 is what it was at that moment. The A1C level on the other hand measures your average over about the past 3 months and is something you really need to know on a current basis.

      2. A Somogyi effect or Somogyi’s phenomenon is unlikely. It’s named for an Austrian-American biochemist who first described the effect in 1938. The Somogyi effect can follow untreated low blood glucose in the middle of the night by going too high as a sort of rebound. You can check if this is happening by measuring if your blood glucose is high at 2 or 3 a.m. But the Somogyi effect is actually much less common that we previously thought, and otherwise it is probably the “dawn phenomenon.”

      3. The Atlantic article is so off-base that I don’t know where to start. But I’ll try! The start of where the author goes wrong is here:

      “Instead of coming to the doctor’s office for periodic tests of blood glucose level and blood pressure, the patients were given tools to draw their own blood and glucometers to measure the level of sugar in the blood….The patient, rather than the doctor, would be the primary day-to-day manager of their disease.”

      It never was “instead of.” It always was in addition to. Yes, it recognized that the patient is the primary manager of diabetes. In the past doctors managed it once every two or three months for a 15-minute appointment. That didn’t work at all! Now, at least we have a chance to manage diabetes on a day-to-day basis. True that many people with diabetes don’t check their blood sugar on a daily basis. Worse, many of those who do check it don’t do anything about it, often because they don’t know what they can do about it. Self-management of our diabetes is a valuable tool that we have when we can use it.

      3. It follows that most people who have diabetes don’t manage it. That’s in spite of the tools we have now since 1979. I keep writing about this and I think that one of my most important article is about precisely this issue, “The Trouble with Glucose Testing” at

      4. You are so right that people who have PRE-diabetes are much less interested in managing it than those of us who already have diabetes, when it’s too late to avoid many of the consequences. This is largely the fault of our medical establishment. It serves people with pre-diabetes even worse than it serves people who have diabetes.

      5. Even though your message made my blood boil, it wasn’t what you said that did it. It was the counterproductive Atlantic article and thinking about all the bad advice we get for managing our diabetes. I do appreciate your thoughtful message.



  • Mike Sheldrick at


    Your comments are spot on. I have never been diagnosed with diabetes, or even prediabetes, but over the years, I note that my fasting readings have crept up to 90 or 92 (lab results). I had an H1AC of 5.0 several years ago. I occasionally test myself and I note that my morning readings on my own blood meter are highest in the morning, sometimes in the high 90s? Somogyi effect? Fractured sleep?

    I have very high blood pressure that is controlled with high doses of a beta blocker, calcium channel blocker and an ARB.

    From what I have read, blockers can lead to diabetes.

    I have gone paleo, nearly ketogenic — so far with occasional cheats. I notice when I consume a slug of carbs, say 35 grams in a meal, my post- prandial readings zoom from 80 to 140 and are slow to come back down. I have read that this can occur with VLC

    So far I haven’t gone to an endo, because I figure he or she will reprove me for not following the recommended ADA diet, and maybe offer more drugs.

    I wonder if I’m insulin resistant (I exercise, walk and resistance), or my beta cell production is diminished.

    I’m not asking for a diagnosis, but I am suggesting that most of what I’ve been able to find on the Web, including yourself, Jenny Ruhl and Dr. Bernstein all seem to deal with people with frank symptoms and high blood sugar.

    My view is that kids ought to learn about diabetes in health class (remember that?) and track themselves through life. This is why I say you are spot on.

    • David Mendosa at

      Dear Mike,

      Thank you. Your higher blood sugar readings in the morning are probably the result of what we call the dawn phenomenon. It’s quite common and not nearly as important as high readings after a meal. You mention your A1C level being 5.0 several years ago. That’s outstanding. Bugt what is it now?