Rusty's Blog

There is a bit of an issue of balance for people who are diabetic. For people who are not aware, a bit of an explanation may be in order. If you know what diabetes is and how it works, feel free to skip the next couple of paragraphs.

Diabetes is the inability of the body to regulate it’s blood sugar level. Humans are not the only creatures susceptible to diabetes, Pretty much every animal that derives energy from glucose being distributed through the blood stream. The mechanism of allowing the cells in the body to take in that glucose to use it as an energy source is a hormone called insulin which acts as a key to allow the blood sugar through the cell membrane. Insulin is generated by stem cells in the pancreas. There are two fairly well known mechanisms that show up that cause issues with the generation of insulin. The first is an auto-immune disorder which happens around the time that the body goes through puberty. Essentially the immune system detects the cells that are generating Insulin as a health hazard, and destroys them. This is called Type 1 diabetes, and the onset is often associated with a flue or cold that the immune system is also fighting. Detection may be weeks or months after the event when several major symptoms of high blood sugar are recognized, and a blood sugar test is performed. The other well documented variety of diabetes appears to be the results of overstimulating the creation of insulin and tends to strike later in life when the t-cells essentially say ‘Hey, enough is enough. You’re over working us, and we’re not going to take it any more.”. There may be symptoms that can be pointed at earlier, such as low blood sugar, but the only way that can provide a significant early indicator is to test for high insulin levels. The problem with that is that the tests to detect high insulin levels are very expensive and at this tome are not as well understood as we would like. About the only time it is performed is when the potential diabetic is known to have a family history of diabetes and is showing signs of being hypoglycemic while eating what appears to be a normal or even high sugar diet. The real problem thous is that what appears to cause Type 2 diabetes is that fat cells in the body are working to reduce the effectiveness of insulin in the first place. The part of the brain that detects high blood sugar, as well as low blood sugar, sends a chemical message to the pancreas saying, “Hay get up off your lazy butt and kick some insulin into the system.” Sort of a bit of a slave driver there.

With most Type 2 diabetics the most obvious hint that the person is may be diabetic is that they are significantly and obviously overweight. In fact some people suggest that it is a result of being overweight. As with most things, the reality is not quite so simple. But if you like the power trip you get from being able to criticize someone for being over-weight, it seems to be as good of a candidate for exploitation as any other I guess. The flaw in the ointment is that there are many people who recognize that Diabetes is something they may acquire, and they work very hard to avoid it. I know several people who if you met them on the street would say that they look to be in very good health, fit, etc. but who I happen to know are diabetic. I’ve even been in that situation.

So back to the premise. Treating diabetes is a bit of a balancing act. On the one hand you have several very bad things that happen over time when your blood sugar gets too high. Kidney failure, neropathy, blindness, etc. There are even some things that happen that don’t take quite so long to manifest themselves. As an example if your blood sugar level is high, scratches and bruises take longer to heal, and may just seem to linger for months when they should clear up in days or weeks. Gangrene can set in, and it’s not at all unusual that people loose appendages. So it’s pretty obvious that you don’t want to have those things happen. The other side of this coin is that if your blood sugar level gets to be too low it can seriously affect your ability to think, react, or even move. Low blood sugar can put you into a coma, and can also kill you. Generally not a desirable situation either.

Insulin dependent diabetics, which can be either Type 1 or Type 2 have to get insulin introduced to their body in response to the food they eat. This may be either through insulin shots, a pump that regularly introduces insulin a combination or some other means. A potential treatment is to replace the cells that generated the insulin in the first place. This has not been an easy process for most people. There have been a few cases where people have had pancreas transplants, usually for other reasons, and have stopped being diabetic, but those are very rare situations, and in most of those cases the imuno-suppressants needed to prevent rejection of the transplants are as much of an issue for ongoing medical care as the diabetes that is no longer the major issue.

Many Type 2 diabetics are not insulin dependent. And in some cases type 2 insulin dependent diabetics do loose the dependency if they respond well to other treatments. There are a few solutions which Type 2 diabetics may respond well to treating. The first is to reduce the uptake of sugar from the consumed food. Some drugs seem to do this reasonably well. We may see some alternatives in the fairly near future though as it appears that there are two varieties of organisms in our gut that deal with the food we consume differently, one of which makes uptake easier and also leads to obesity. The other seems to reduce the uptake of carbohydrates and calories from the food we consume, or at least does not make it easier to convert. I suspect that we will see more research and treatments investigating that in the near future, both because there is a large population of people who would like to loose weight that this might help, and because it does affect how the food we eat is processed.

Another attack on the problem is to address the other major method of introducing blood sugar to the system. That is the conversion of fat into glucose. This process is actually done in the liver. The vast majority of the glucose that is converted from the food you eat is transfered into your blood stream within 4 hours of eating. There are a few complex proteins that are handled later on, but for most of us that is not a significant portion of our diet. Since most of us spend between 6 and 8 hours of every 24 hours asleep, and onset is often several hours after we have eaten, you would expect that overnight our blood sugar levels would drop significantly. That is where our lives kick in and convert some of the stored fat we all carry around into glucose. On the off chance that this is entirely too efficient at working, some drugs try to suppress this function.

Another variety of treatment for Diabetes is to induce the pancreas to generate more insulin again. There are several medications that do this in one way or another. There is also a third fairly new attach which attempts to suppress the insulin resistance mechanism. Because of the reduced effectiveness of the insulin generation process in the first place, it is not uncommon to combine the treatments in various ways.

What turns into a fairly significant issue over time though is that people who finally find a way to manage their blood sugar, also end up setting up a situation where it becomes very easy to gain weight. The ‘working’ cells are not the only ones that make use of insulin to let glucose in. Fat cells do the same. As a result if you combine the increased capture of glucose by the fat cells and convert it to fat, with the suppressed conversion of fat to glucose enabled by the Liver, you set up a situation where it is easy to gain a significant amount of weight.

Balance in this case is not limited to keeping your blood sugar ‘controlled’ it is also a matter of figuring out what is the right amount of food you should be taking in in the first place.

“Oh, well, I’ll just exercise more.” some might suggest. Actually, it doesn’t work out quite that way. Getting to humans, there are three things our bodies are very clearly designed to do, and do with efficiency. The first is to run. No, we don’t run all that fast when compared to other creatures. In fact most other creatures can outrun us for a good distance. I’ve considered adopting a greyhound over the last couple of weeks. Within 3 strides, less than 40 feet, a greyhound can go from a standing stop to 40 miles per hour. Buffalo at full gallop are over 30 miles per hour. Horses, deer, antelope, goats, and so on. Try to keep up with a cat. Humans on the other hand can run for very long periods of time. If you train to run, you soon learn to leave your dog at home. They make wonderful sprinters, but if you are going to run a 5k, you will run them into the ground. Even if you are not ‘fast.’ The fact that most of your run is a controlled fall, and you are simply using two legs and feet to do that with means that you can do that more efficiently over long periods of time. How much more efficiently? A marathon runner who completes a marathon in about 3-4 hours, which means not usually an elite runner, burns up about 1000 calories during the run. Sounds like a lot eh? McDonald’s has been selling an Angus Burger sandwich that is alone 720 calories. Add in a medium fries at 300 calories, and before you’ve added a drink you’ve got more calories on your plate than a Marathon runner burns off in an event.

The second thing that humans are absolutely great at is using tools. When it comes down to it, this is more of an indication of our fine motor abilities in our hands than anything else. And a significant part of that is our very flexible thumb. That’s not really all that great for consuming calories however.

The third thing that really takes the cake though is our brain. Fully 20% of our daily calorie usage is devoted to brain functions. The average human consumes roughly 2500 calories a day. Highly active people, say recruits in basic training may be up over 3500 calories, but that’s not most of us. So looking at that 2500 calories, just sitting around, thinking all day, and being moderately active, our brain uses as many calories a day as a marathon runner uses running the event. Most of us are not aware that our brains are working that hard, but they are.

So, what does that mean for someone who wants to loose weight? First of all, you want to achieve that moderate level of activity or better. I won’t go into whether most of us do that or not, iI doubt if we do. How many of us can identify with the guy who gets up to go get the mail out of the mail box, and realizes on his way back that he’s winded, and he didn’t get any mail today? Moderate activity is there to help you. Go for a walk. start slow if you need to. (If you get winded going to the mail box, you need to.) Talk to your doctor and find out what a ‘moderate’ level of activity for you is. For a lot of people it’s about an hour of activity that increases the heart rate into your aerobic zone, for over an hour a week. 3 days of 20 min walks is a good start. Go further if you would like, or increase speed. It’s up to you. If you would rather dance, do that. If you have seen those ‘magic sticks’ and want to give that a try, then by all means try it out. It may look easy in the hands of the guy selling the things, but it will take time to learn. For that matter learning to Juggle will very likely change your activity level.

However by doing that you are adding ‘moderately active’ to your self description. That doesn’t change the fact that you are going to have to do something to reduce the calories taken in. If you are consuming 3000 calories a day, and have a moderate level of activity of 2500 calories consumed daily, that’s a 500 calorie surplus every day. 3500 calories every week. If you like those Angus Burgers at McDonald’s, that’s less than 5 of those a week. The added weight will pile up fast.

So the idea is to do what you can to helpfully affect that balance. And you are probably aware that if you drop to under 1500 calories you actually induce a new effect in the human body. You introduce the body to starvation mode. I won’t go into the details, but in summary, you don’t want that.

Balance. Take your time, and do it ‘right.’

Oh, and one guy who realized that he was wonted when he went to the mail box, addressed it by developing a program which took him from the couch potato he was, to a 5k runner in about 9 weeks. He now runs marathons.

I’ve made no secret of the fact that I am diabetic. I have type II diabetes. On it’s own, it probably won’t kill me, though it will probably contribute to my death. Whenever that happens. In a review of what my life has been like, and what my personality is, I have no doubt that I will end up dying of something preventable. I’ve no interest in suicide, but that is far from the only ‘preventable’ cause of death. It would not surprise me to find I die in a car accident, or from doing something that I should know better than to do.

Some things that I’m pretty sure will not kill me are alcohol related events (on my part) and I doubt strongly that I will die directly of smoking related conditions, though indirect exposure may have an impact.

Pretty heavy so far eh? Sorry about that, it will get a bit easier along the way.

Back a few years ago, I realized that I weighed too much. I knew well enough that being overweight was a contributing factor to people becoming diabetic (Type II, Type I is a different set of conditions in most cases.) and in as I had lost an aunt and two uncles to the side effects of Type II Diabetes, I took action. Apparently too late. I did loose weight. I went from a high of 260 lb as I weighed myself in the morning, down to a low of 170 lb. One of the things I was hoping to see happen in the process was that I would regain some of my ability to run.

In High School I ran in cross country, and track. I wasn’t very good, but I did run. Running is also one of the things you do when you are in the Army. When I was deployed in Saudi Arabia, I started running around the towers coumpound twice a day. I had  hoped that I would continue that once I got back to the states, but ‘life’ got in the way. I did enjoy running though, and when I was running, I would weigh in the neighborhood of 160 to 170 lb.

But as I say, once I dropped down to the 170 to 180 lb, I didn’t regain my running ability. I can jog about half a block, maybe a block or two if I’m not carrying anything, but that’s about it.

Somewhere along the line, my heart lost some capacity for pumping blood. About the same time I was diagnosed as diabetic, I had an ultrasound done of my heart and caratoid arteries, and a stress test, and it turns out that my heart is functioning at about 70% efficiency. I.e. about 70% of the blood is ejected from the main ventrical every time my heart pumps. It compensates for this by pumping at about 20-30 bpm higher than the ‘normal’ resting rate of 60 bpm that most people have. If we do have a limited number of heart beats to live through, I could be said to be getting close to living on borrowed time. However that’s not one of my personal beliefs. Additionally it’s only been within the past 20 years that my heart rate has become elevated, so I should have some time to go.

When the results of the ultrasound came in, my doctor suggested that it looked like I had experienced a heart attack at some point in my life. A normal cause of loss of function for the heart is a heart attack. However after my stress test, my cardiologist (I should set up an appointment with him soon as well) noted that while it’s true that I do have reduced function, he does not see any indications in the ekg or the stress test that it was related to a heart attack. We shall see what comes up after I have a followup with him (or another cardiologist.)

One of the reasons that this is of interest, is that simply because I am diabetic, I have a 50% higher risk of dying of heart failure than people in the general population. Another reason to take interest in this is that one of the varients of one of the medications that I take for Diabtes has been linked to heart failure for people with congestive heart disorders. I am not taking that specific medication, however Actos is in the same family, and while the study did not show a strong corelation for Actos, my doctor is concerned, and I understand that concern.

When I visited my doctor about a month ago, I had been off all medication for the better part of 8 months. My fasting blood sugar reading was 280 by the finger stick test, but the lab test showed a reading of 320. Note that a ‘normal’ fasting reading is under 100 milligrams of glucose per decilitre. Just reading over 120 two times is sufficient for a diagnosis of Diabetes. I don’t think I’ve had 2 fasting readings under 120 in the past month. For the purpose of that statement a ‘fasting’ reading is a reading that is taken more than 8 hours after my last meal. A contributing factor to this situation is that when you have not eaten for some time, your liver goes into starvation mode, and starts converting fat into glucose and dropping that into your blood stream.

As most diabetics know, one of the log term indicators of good control over sugar in your diet is what is usually called an A1C test. The way this test works is that red blood cells are ‘damaged’ by excess glucose in the blood stream. Your bone marow produces red blood cells, and they have a 90 day lifespan in your blood stream after which they are filtered out by your kidneys and ‘pissed away.’ the A1C test takes a snapshot of the damage to the red blood cells in a blood sample, and assigns a ‘damage’ assesment. I am not sure how most people consider the number, but if you think of it as a loss of carrying capacity for oxyogen in a blood cell, we can work with the system. ‘Normal’ blood sugar levels will introduce some damage to the red blood cells, The value is between 5% and 7%. When I visited my doctor, the value their equipment at the clinic was able to report was >14%.

I don’t expect to be getting an A1C evaluation done when I visit the doctor this time. If I do, I do not know if it would be meaningful. Oh, it might show a reading of 12 or 13%, which might back up the testing that I have been doing for myself, but it is not a given. The damage to blood cells over the period of the 2 months prior to my last visit doesn’t ‘improve’, though it should be ‘lesser’. The problem with that sort of an assessment is that it took about 2 weeks for me to get what I would call my daily average under 200. And I still spike over 200 after meals. That may improve depending on the medication that I start taking, but the most promising medications are some that I very likely won’t be getting, as they are the most expensive, and their long term side effects are still unknown. One of those may help with my overnight blood sugar rise, as it basicly tells the liver to hold off on the conversion of fat to glucose. It appears to be doing wonders for the son of a co-worker of mine.

I do wonder at times if having liposuction would help. The logic behind that is that one of the reasons that people become type II diabetic is that fat cells appear to be doing what they can to stay in shape. (I.e. stay filled with fats.) They do this by increasing the bodies resistance to Insulin. (Called obviously enough insulin resistance.) The question becomes if someone looses half a liter or so of fat cells via liposuction, (that’s about a lb of weight, but a quarter of the volume of a 2 liter bottle) does their resistance to insulin go down noticably. The supporting question would be what varieties of fat or other body cells increases the resistance of the body to insulin. If the predominate variety of these cells is those around the abdomen and legs, then a reduction in the number of these cells fhrough liposuction may have a positive influence. On the other hand if it is the variety of fat cells that are within the muscles of the body, then while the total fat cell volume goes down, the percentage of fat cells increasing insulin resistance goes up. I don’t think this would have a specifically negative result, however not having a positive effect would tend to be disheartening to many people.

Am I ‘getting better?’ Well that depends upon what you consider to be ‘getting better.’ I am not expecting science to come up with a magic bullet to cure type II diabetes. The best that I can hope for there is to ‘control’ my blood sugar levels and over the long term hopefully the damage to my body will be reduced. Some of the side effects of diabetes includes taking longer to heal damage to the body. Some damage will not ‘heal’ of course. If you tear a tendon off of it’s bone or muscle, it doesn’t self correct. The best you can hope for is that you get surgury done to reattach the tendon with stitches. However some of the other side effects of normal ‘wear and tear’ to the body do ’self repair.’

As an example, when you work out at the gym, walk or run, one of the side effects of the workout is that in burning the sugar in your blood, your muscles generate lactic acid. This acid ‘damages’ the muscles, which is why a day or two after a heavy workout, your muscles get sore. Likewise most of use experience scrapes and cuts from day to day that scab over and we go on, and a week or so later the scab falls off and we have a light scar there. The effect of Diabetes is that your body’s repair system does not work well in a high sugar environment. So a diabetic with an uncontrolled blood sugar level will spend more than a couple of days with those sore muscles, it may be weeks or longer. Likewise scratchs may never seem to heal up.

One of the first thing that people who have been living with uncontrolled diabetes discover after getting their blood sugar under control is that the scabs that just wouldn’t go away finally do. Doctors and nurses who were working with me when I was first diagnosed with diabetes said that I was going to feel much better. In part this would have been due to muscles finally repairing, but also joints swell as the body works to get the excess sugar out of the blood stream into other places.

My first obvious experience was that I didn’t have to ‘pee’ all the time. But I never really felt bad when I was first diagnosed with Diabetes. At least not in the muscle aches, back aches, joint problems varieties. This time, and a few other times when I know my blood sugar had been elevated for some time, I felt it in my lower back, and I am still feeling issues with one of my arms that I’m expecting to see some improvement over the next month with. Though I will discuss it with my doctor tomorrow.

In the sense of not feeling that pain, yes I am getting better. Still some ways to go, but that is likely to be the case for some time. So my response is ‘Yes, I am getting better.’

I hope you are too.