Thursday, July 28, 2011
Fasting Glucose: 81.
Glucose 1 hour after lunch: 97.
Blood pressure, resting pulse: 115/73, 56.
Exercise: 4 mile run.
Right now I am blogging when I ought to be packing. I leave for Lark Camp tomorrow. It's a big annual gathering of traditional musicians, at the Mendocino Woodlands (about 8 miles inland from Mendocino, on the Northern California coast).
The camp is so isolated (a big chunk of the road back to Mendocino is unpaved) that you have no distractions from outside. The outside world disappears for a while (I will have to let somebody else fret about whether or not the oversized infants of Washington DC are going to let the government go into defualt while I'm away). All that you have on your mind is music, day and night.
In the daytime there is a regular schedule of workshops -- informal little classes, mostly taking place outdoors wherever shade can be found (which is easy) and wherever flat terrain can be found (which is hard).
Although Lark Camp is devoted to traditional music, there are a lot of different traditions included. Irish is the most prominent. But to give you a rough idea of the level of variety on offer, let me list the workshops I'm probably going to attend, alongside a few examples of the many other workshops taking place at the same hour. (There's a great deal more going on than the examples I include would suggest.)
It's a busy day. Also, the workshops take place in three different camps and I have to ride my bike back and forth between them. (Well, I could take the camp shuttle bus, but riding my bike helps me work some exercise into the day.)
In the evening, there are some interesting events scheduled (concerts, dances, silent movies shown with an orchestra providing musical accompaniment), but playing in jam sessions is the main activity. There are a lot of these sessions, and they're all different, so you wander around camp and join whichever one seems right for you. If it changes in a way you don't like, you go find another one.
What's hard to describe to someone who hasn't been to an event like this is how wonderful it is to be totally immersed in music for several days. After the first day, you're constantly "warmed up"; your brain is in music mode, and your inhibitions fade, so that you can relax and play well. The saddest part of coming home from camp is knowing that you're now going to come out of music mode, and tense up, and not be able to play as well as you know you did at camp. If only we could spend every day immersed in music to that degree.
Although, in years past, it has usually been possible for me to participate in Lark Camp without having any conflict with the requirements of diabetes management, I had some trouble with it last year, and I want to make sure I don't repeat that.
The biggest problem last year was that, in comparison to earlier years, I didn't get as much exercise as before. Because of the way the workshop schedule was arranged last year, I simply didn't spend enough time riding my bike back and forth between camps to meet my exercise needs -- and I did almost no running workouts to make up for it.
The workshop schedule this year will probably have me spending a total of an hour a day on the bike, so probably I won't be deficient in exercise this time. But if I don't like the glucose test results I'm seeing, I will have to fit in some running as well.
The other issue was the high-carb diet at camp. It's not that they don't offer any lower-carb foods; the problem is that the best things they offer are almost always high-carb. For example: at breakfast they frequently offered a Mexican rice dish (a little like a hot rice pudding) which was delicious but very sweet and clearly very high-carb. I loved it, and I never should have had anything to do with it. I allowed myself to be overwhelmed by the feeling that I was on vacation and I ought to be able to eat whatever I felt like eating. I've decided that I can't afford to let myself be overwhelmed by that feeling again this year. I was able to maintain good glycemic control at Lark Camp before; this leads me to believe that I can do it again.
Wednesday, July 27, 2011
Fasting Glucose: 83.
Glucose 2 hours after dinner: 99.
Blood pressure, resting pulse: 107/68, 63.
Exercise: 7.5 mile trail run.
I was going in to work a little early, because of an early meeting. After breakfast I hastily together the things I needed for running today -- shirt, shorts, socks, hat -- and put them in my gym bag, where it sat on the floor by my front door. Then I departed for work, leaving the bag sitting right where I'd put it.
Is this sort of thing the beginning of Alzheimer's, I always wonder, or just a continuation of the same sort of absentmindedness which has tormented me for my entire life? It cannot be denied that I've always been very good at forgetting things, losing things, overlooking things, and missing the point of things. But maybe I'm even better at it lately. Hard to say!
As I couldn't run at lunchtime, I decided to make up for it by doing a good long trail run at the state park after work. It was sunny and warm, but not warm enough to be uncomfortable for running (I choose a route that kept me in the shade a lot of the time). Trail-running on Wednesday evenings used to be routine for me during the summertime, but I haven't been doing during the last couple of years, and there was a certain nostalgia about it. Each part of the route reminded me of past experiences on those same trails from years ago.
Crossing a dry creek-bed that marked the beginning of the most difficult part of the whole route (it's about a mile of steep, constant climbing), I was thinking "Okay, here's the part where it gets really hard", when a young runner passed me, saying "here's the part where it gets really hard!". I gasped my agreement; it didn't seem to be all that hard for him, to tell you the truth. And although it was, indeed, a hard climb for me, vivid memories came flooding back of the time, on a Wednesday-evening run several years back, when I first ran up that hill, which I had long been avoiding. It was much, much harder then. Hard to the point that I had wondered if I was going to die before I got to the top. Could people do such things and live? Or rather, could someone like me do such things and live? It then turned out that someone like me actually could. I don't know when that was, but I think it must have been at least seven years ago.
The rest of the route was full of memories, too. Oh, look, here's where I encountered that guy, on another Wednesday night run, who stopped me to ask what I was training for. I remember telling him I was training for the San Francisco Marathon, so that would have been the summer of 2006. Five years ago. Seems like yesterday.
Oh, look: here's where I tripped last year, running downhill, and bit the dust! I sure lucked out on that one -- I landed on what was probably the softest and most rock-free patch of dirt in the whole park. No injuries, but I never did manage to launder the red-earth stains out of my white Kenwood Footrace T-shirt.
For most people, the main thing that triggers a flood of nostalgia is hearing an old pop-song, or hearing about the death of some famous person who influenced us in younger days. For me, exercise is usually what does it. Fortunately, the memories are usually about how much harder something used to be for me, in the first year or two after I was diagnosed. When the memories start to be about how much easier it used to be for me then, I guess that will be the signal that I really am over the hill!
Tuesday, July 26, 2011
Fasting Glucose: 84.
Glucose 1 hour after dinner: 131.
Blood pressure, resting pulse: 119/72, 58.
Exercise: 4.5 mile run.
It's nice to see my fasting result under 85, and not quite so nice to see my post-prandial result over 125, as I didn't think there was enough carbohydrate in my dinner to produce much of a high. Well, you never can tell.
Once again, I'm browsing through the search strings that have caused Google to refer people to this site recently, and wondering whether the people doing the searching actually found the answer they were seeking.
am i getting diabetic damage at 149 post prandial
I used to think the answer to that was "no", since my doctor advised me to keep post-prandial results under 150, and I assumed that meant anything up to 150 was normal and safe.
It turns out that a "normal" post-prandial result (that is, in someone who doesn't have diabetes) is actually 125 or less, and there is at least some evidence to suggest that going any higher than that does a certain amount of harm, or causes a certain amount of elevation of risk of harm.
The biggest concern, if you ask me, is that elevated glucose levels may cause enough "glucotoxicity" to the beta cells in your pancreas to cause a reduction in your insulin-producing capacity. Obviously, if that happens, things can spin out of control: the more insulin you need, the less you make. To avoid getting into that situation, I try to keep my post-prandial results in the normal range (125 or lower) as much as I can. I didn't quite succeed tonight, obviously, but that's what I aim to accomplish, and often I do accomplish it.
abe ramos diabetes
abe not impress himself
Obviously these are people hoping to update themselves on the achievements of diabetes star Abe Ramos, who was profiled here last fall. Whether or not it is true to say that "Abe not impress himself", I don't know; you'd better ask him directly.
diabetes patient not peeing enough
i have diabetes and can't make it to the bathroom in time
The latter problem seems more diabetes-related than the former. When blood sugar levels get very high, the kidneys try to flush the glucose out of your system by dumping it into your bladder, and this results in excess urine production -- a classic warning sign of diabetes. It turns out that diabetes mellitus isn't the only disease that can cause frequent urination, but it's the common one. As for infrequent urination, I suspect that would have more to do with dehydration or some other problem than with diabetes.
if flies come to your urine does it mean you can possibly have
people with diabetes more apt to attract bees
When the kidneys try to get rid of excess sugar in the blood by dumping it into your bladder, the sugary urine which results is notoriously attractive to ants and bees; this was how diabetes was recognized in ancient times. However, we now have slightly more reliable methods of detecting excess sugar in the blood, and it's best not to really on insect behavior to tell us what's up.
effects of running a marathon on type 2 diabetics
I have run four marathons; my experience is that the effect of running a marathon on people with type 2 is the same as the effect of running on people without type 2. That is, it's very difficult and tiring, and afterwards you are very sore, especially in the quadriceps muscles, for a couple of days. You do need to make sure you fuel yourself sufficiently during the race to prevent hypoglycemia, but the same is true for people without diabetes, too.
gluocose a1c 6.2% low average glucose level daily
109 glucose 6.2 a1c readings serious
6.2 level of a1c but normal blood glucose
a1c 6.2 insulin resistance
what does a 6.2 a1c mean
Whenever anyone inquires about particlar A1c levels, it always seems to be that 6.2 is the particular level they want to know more about. I don't know what to make of this coincidence. Anyway, 6.2 is a little above normal, and although many doctors would consider it "not bad for someone with diabetes", I would recommend getting your A1c result below 6 if you can, and not agonizing over it if you can't.
in non diabetic is 110 gluclose reading in morning ok
Any fasting level above 99 is usually defined as abnormally high. In most people who don't have diabetes, the fasting level is closer to 80. I think it's best to aim for normal rather than for not-bad-for-someone-with-diabetes, but sometimes you have to settle for the latter. Well, settle for it if you have to -- but don't settle for it if you don't have to.
is 92 a low glucose reading after dinner
It's unusually low, but not dangerously low. If you're taking insulin or other meds, though, you might have to keep an eye on the situation to make sure you're not going lower than that.
pulse of 116/79 good or bad
Good -- assuming you really meant blood pressure, not pulse.
what happens when unmedicated diabetic eats sugar
The same thing that happens when anyone eats sugar: it is very rapidly broken down and released into the bloostream as glucose. What happens next depends on how insulin-sensitive you are and how insulin-productive you are. If you can't produce a lot of insulin, or your cells aren't very responsive to insulin, your blood sugar is likely to go high.
why is being a type 1 diabetic so depressing
Perhaps because it's so frustrating. It's harder to control than Type 2. Thre are rules to follow, but you can't count on them working for you every time.
Another problem is that bystanders apply everything they've ever heard about Type 2 to the unrelated Type 1, on the assumption that there is only one kind of diabetes. The result is that people will advise someone with Type 1 who is already thin that he should lose weight in order to get rid of the problem. I can imagine this getting old after a few decades.
what would happen if my blood sugar is 325
A little bit of damage to tissues and organs all over your body, if it doesn't go on very long; a lot of damage to tissues and organs all over your body, if it continues for a long time. Eventual result: just about every kind of health problem conceivable. Best not to go to 325, or at least not to linger there any longer than you can help.
when should your postprandial be the highest
"Should" seems like an odd choice of words. There isn't a time of day when it is somehow better to get a high post-prandial result.Let's rephrase the question as "when can you expect your postprandial to be the highest".
Many people do worst after breakfast, but whether this is because their physiology is different then, or because breakfast tends to be a high-carb meal, is hard to say.
If you are aware that you tend to have higher post-prandials at a particular time of day, be extra-careful about carbs at that time.
I tend to get higher results after dinner than after lunch; I assume this is because I usually eat lunch after running, so I get a better result then.
Monday, July 25, 2011
Fasting Glucose: 90.
Glucose 1 hour after lunch: 100.
Blood pressure, resting pulse: 102/69, 58.
Exercise: 4.1 mile run at lunchtime; yoga class in the evening.
E-mail directed at this site is usually very diabetes-specific, but there are exceptions. Here's one that I got today:
Dear Sir or Madam,
Have a nice day! I'm Gordon from Megacolor International Ltd. We have gained your information from google. Wish to establish a long- term business relationship with you in the future.
First let me introduce our company to you.We have nearly 100 staffs,and our factory area is about 5,000square meters.What's more, we have our own unique R&D team and over excellent designers.
Our main business scopes
are as follows:
1.Zirconia Ball-Grinding & Zirconia Structure Ceramics, Zirconium silicate bead. etc ceramic ball
2.Zirconium Powder- Yttria Stabilized Zirconia(YSZ)
3.Ceramic knife,Ceramic knife set,Ceramic Peeler & Ceramic Scissor
Please visit our website xxxxxxxxxxx if you want to know more details.And don't hesitate to contact me if they draw your interest.
Looking forward to hearing from you soon!
Best wishes & Regards!
Megacolor International Ltd.
china changsha zhonglong chemical co ltd
Perhaps you're thinking that I am very foolish to have ignored this once-in-a-lifetime opportunity to partner with Gordon and his nearly 100 staffs, over there at the ball-grinding facility at zhonglong chemical ltd, but the truth is that I think the sole purpose of the e-mail was to get me to click on a link which should not be clicked on (and which I am suppressing here for that reason).
The internet is the best of media, and the worst of media. Forget the scam artists -- that still leaves us with a scattered army of more whimsical trouble-makers.
Never has there been so much opportunity for people to locate those who share their specialized interests -- and shriek obscene insults at them. The interesting thing to me is that the subject of discussion doesn't have to be abortion or the Gaza Strip to unleash these floods of abuse. Any subject at all can do it. I saw, with my own eyes, an exchange of F-bombs yesterday between those who differed on the relative merits of the tenors Jonas Kaufmann and Rainer Trost, as interpreters of the aria "Un Aura Amorosa" from Mozart's 1790 opera Cosi Fan Tutte. I haven't visited any websites devoted to knitting or bird-watching, but I'm perfectly confident in predicting that people are just as ready to get into gutter fights about yarn controversies, or the proper identification of the Ruby-Crested Bloatneck. That is, they are willing to do so as long as they are anonymous. There is nothing quite like anonymity for making people feel sure that it doesn't matter how they treat their fellow citizens. Where there are no real names, there are no real rules.
It's hard to talk about diabetes at all without infuriating some partisan of a diabetes therapy (and especially a diabetes diet) which conflicts with what you're advocating. Many a diabetes forum on line has been brought to its knees by the more apocalyptic brand of dietary evangelism.
I wish I could brush all this aside, and conclude that it doesn't make any difference how nasty people are on line, because they won't dare to transfer their whimsical rage to the real world, where it might have actual consequences. However, the mass-murder story from Norway is reminding me that internet trolls are not always content to be nothing more than internet trolls.
Friday, July 22, 2011
Fasting Glucose: 93.
Glucose 1 hour after lunch: 105.
Blood pressure, resting pulse: 113/69, 56.
Exercise: 4.1 mile run.
Well, a fasting test of 93 is a step up from yesterday's 81, but it's still in the acceptable range. I think it was up because I had a light lunch yesterday, and came home so hungry that I couldn't resist having too big a dinner. No, wait a minute -- I should just say that I didn't resist having too big a dinner. Whether I could or couldn't have resisted having too big a dinner is a different question altogether. It raises a lot of philosophical issues about Free Will and things like that.
I suppose that philosphical issues about Free Will and things like that should figure somewhere in the controversy about McDonald's and the Olympics.
The McDonald's restaurant chain has played an increasingly prominent role as an Olympic sponsor in recent years...
...and some people are unhappy about how far they are planning to carry this at the 2012 Olympics in London. Apparently the idea is to make McDonald's more or less synonymous with the Olympics.
At the London games, McDonald's will set up four temporary restaurants, one of which is expected to be the largest and busiest restaurant in the world, seating over 1500 customers, and expecting to serve 1,750,000 meals during the four weeks' duration of the event. McDonald's has an exclusive deal with the Olympic committee, making it the only branded restaurant at the event.
The problem here, as some people see it, is the British government had pledged to create "the healthiest Olympics ever" and to use the event "to get two million more Britons to adopt an active lifestyle to try to battle obesity". Making the event look like an auxiliary activity of the McDonald's organization seems to strike the wrong note. Yesterday the British Medical Association issued a statement complaining about the situation. "Given many countries in the developed world, and some in the developing world, are facing a major problem with obesity, it is unfortunate that McDonalds are major sponsors at the 2012 London Olympics. The BMA does not believe individuals should stop buying McDonalds but we need to get the message across that these products should be seen as very rare treats."
Another critic, Grahame Morris (of the Parliament's health committee), said, "Given the huge public health issues of childhood obesity, it is legitimate to question whether having the world's biggest McDonald's at the Olympic Park is sending an appropriate message to our young people."
McDonald's has replied as follows: "There is no doubt that McDonald's food can fit into a balanced, active lifestyle and we offer a range of choices on our menu, as well as nutritional information on our trayliners, website and on packaging, to help our customers make an informed choice."
There is no doubt? I thought there was doubt, and quite a lot of it, about every aspect of nutrition. (If there is anything like a universal consensus on what constitutes a healthy diet, it is news to me.) But it does seem possible that one could eat at McDonald's once in a while and still be in great shape.
However, it seems unlikely that McDonald's is heavily involved in Olympic sponshorship in order to promote the idea that it's okay to eat at McDonald's once in a while. Aren't they promoting the idea that eating at McDonald's frequently is normal, healthy, fun, and the sort of thing that top athetes do?
Other sponsors of the 2012 Olympics include Coca-Cola and Cadbury, so it appears that cola drinks and chocolate are also important elements of an active lifestyle.
I can see why people are unhappy about the way that corporations which are arguably in the business of selling diabetes are wielding such influence over the Olympics. But what else can we expect? The Olympics are very expensive events to put on. If the governments of the participating countries are not going to cover the costs, then the people running the Olympics are going to have to sell themselves to the highest bidder. We shouldn't be astonished to discover that they are doing exactly that.
I find it hard to understand why anyone's decision to have lunch at McDonald's, or not to do so, would be driven by their awareness that McDonald's is an "Official Partner" of the Olympics, but such considerations must matter to some people. Otherwise, McDonald's wouldn't be willing to spend money on this project.
Regardless of who is sponsoring the Olympics, and how we feel about such commercial arrangements, we do have the option of ignoring the message, and eating whatever we think is good for us. It's just that ignoring it takes a lot of effort sometimes. It guess this is where that Free Will thing comes in.
Thursday, July 21, 2011
Fasting Glucose: 81.
Glucose 1 hour after lunch: 122.
Blood pressure, resting pulse: 112/70, 59.
Exercise: 4.4 mile run.
Still on track. Good fasting result today. Acceptable post-prandial result; higher than yesterday, but lunch was higher in carbs this time (it included some fruit).
The Law of Unintended Consequences applies to everything else, so why shouldn't it apply to clinical medicine?
It seems to me that doctors, and organizations of doctors, sometimes dream up ideas which they think will create a healthier society, when the likelier result is that they will create a society in which people are afraid to go to the doctor. Two examples of this issue came to my attention today.
First, the American College of Obstetricians and Gynecolgists declared today that healthcare providers should "routinely" screen female patients for "a history of sexual assault". The idea is that women who have been raped will often say so if you ask them, but won't if you don't. Maybe that's true, but do most women really want to be quizzed about that subject every time they have any interaction with the health care system? Arguably this is none of my business, as I'm not one of the patients who is going to be screened, but if I were, I don't think I would look forward to it.
Second, a Boston pediatrician named David Ludwig and his coauthor Lindsay Murtagh wrote an opinion piece in the Journal of the American Medical Association entitled "State Intervention in Life-Threatening Childhood Obesity", which (apparently) suggested that severely obese children should be taken from their parents and placed in foster care. Surprising as it may seem, this modest proposal upset a lot of people.
Owing to the strong public reaction, JAMA claims to have made the full text of the article available to the public for free. They didn't actually do so, however. I've visited their site, and the full text of the article was thoroughly barricaded and inaccessible, and surrounded by spikes and barbed wire. The only thing they have made available is the first 150 words of the article, which give no clue to the controversial nature of what reportedly follows.
So now Dr. Ludwig is mad about how his text (whatever it actually was) has been interpreted and misrepresented and reacted to. "It's just been heartbreaking to see how the story has been wildly exaggerated by some of the media, causing a great deal of pain and suffering for people." You see, Dr. Ludwig was only suggesting foster care as an absolute last resort; in most cases it wouldn't be necessary! It would be almost freakishly rare, in fact! Which raises the interesting question of why, if that is true, he thought it was necessary to write an article called "State Intervention in Life-Threatening Childhood Obesity" in the first place. So far as I know he hasn't bothered to write an article on protecting children from asteroid collisions, but this one seemed to him worth the effort; seemingly he thought he was addressing a real issue which comes up often enough to merit discussion. It's just that the response to his suggestion was not what he expected.
Imagine parents over-reacting to hearing that having a fat child means you're a negligent parent and should lose custody! It just shows how ridiculously touchy certain people can be, doesn't it?
Or maybe it shows how unimaginative certain other people can be. I've been trying to imagine how the good doctor could have thought that his brainstorm would upset no one; if I come up with anything plausible I'll let you know.
It seems to me that, if you're going to practice medicine, and you don't want to deal with human relations or human feelings, you'd better take up veterinary medicine. When you practive human medicine, humans sort of come with the territory, whether you like it or not!
Wednesday, July 20, 2011
Fasting Glucose: 85.
Glucose 1 hour after lunch: 104.
Blood pressure, resting pulse: 104/66, 61.
Exercise: 4.5 mile run at lunchtime; weight-lifting in the evening.
Good glucose numbers today -- I'm glad to see that they are continuing to trend in the right direction, after my elevated readings the day after the half-marathon.
It was warm today (in the high 80s), so my lunchtime run was a little harder than usual. After the run I paid a visit to the "Heart Health Wellness Fair" that was going on at my workplace today. I wanted to ask some questions at the blood-pressure booth without actually letting them test me (after a hard run I was sure it would be high). The nurse there was willing to keep it conversational for a while, but eventually she pretty much insisted on testing my blood pressure just to see. It turned out to be 118/82, which was lower than I expected, and also lower than she expected -- but by that point something like 30 minutes had elapsed since the end of the run, which (based on prior experience) is usually enough recovery time for me, after aerobic exercise.
Anyway, based on the test and the details of our conversation about blood pressure and heart rate, she told me I was healthy and doing a good job of managing the situation.
She told me about some interesting factors which affect blood pressure and heart rate, especially if you exercise in warm weather. For example, as your body heats up, the cardiovascular system tries to help cool you down by increasing peripheral circulation (that's why you get red in the face), and this places greater demands on your heart. Also, as you get dehydrated, the viscosity of your blood increases, and this also places greater demands on your heart (thicker blood is harder to move around through the arteries).
On a more general note, she said that blood pressure has a tendency to rise as you get older, simply because the walls of your arteries become less elastic. However, this development can be counteracted, at least to some degree, by adaptations which occur in people who exercise regularly. One of these adaptations is refurbishment and expansion of the arterial system. Your body can, in effect, perform its own heart bypass operation, by adding secondary arteries to supply more blood to a section of heart muscle which hasn't been getting enough. It takes time, though -- your body can't accomplish it on an emergency basis. Better to stay active, and stimulate your body to work on this issue while there is still time. By the time you have angina, it's a little late.
Some photos were published of the race on Sunday. Here are some of the 3200 participants starting to gather at the starting line.
The photographers caught several images of me running amongst the vineyards...
...and the ones that were taken comparatively early in the race paint a vivid portrait of a guy who is strong, energetic, full of confidence, and about 15 pounds overweight.
The finish line photos capture a vivid portrait of a guy who is weak, tired, and full of self-pity, but only about 12 pounds overweight.
If only the weight you lost during a race didn't come back as soon as you got rehydrated!
The distant planet Pluto, tiny though it is (smaller than our own Moon), nevertheless has three tiny moons of its own. Wait -- make that four tiny moons of its own.
To the moons Charon, Hydra, and Nix, astronomers must add a new one, discovered a few weeks ago. It doesn't have a name yet; for now it's referred to as P4, and it is the tiniest of the tiny moons of the tiny planet.
How tiny? Well, the astronomers are still taking observations to try to get a more accurate value of P4's diameter. But it seems to be about 13 miles.
In other words: the length of that race I ran on Sunday. Call me self-centered, but that's my way of keeping geographical and even astronomical facts in perspective.
Tuesday, July 19, 2011
Fasting Glucose: 91.
Glucose 1 hour after lunch: 112.
Blood pressure, resting pulse: 115/68, 61.
Exercise: 4.5 mile run.
Well, today was a better day all around. I'm getting back on track. Fasting test down to 91 after yesterday's unwelcome climb to 100. Post-prandial was 112. Blood pressure was unusually low.
I felt better, also. My hamstrings and quadriceps muscles, which were so sore yesterday from the half-marathon on Sunday, were much improved, and I was able to run today. Actually, my muscles were complaining a bit loudly for the first mile of the run, but after that they loosened up, and running felt fine.
Even the fittest and most disciplined people with Type 2 diabetes have setbacks -- and the better you're doing most of the time, the more alarming a setback tends to be. The important thing is to get alarmed just enough to become motivated to get things back under control, but not so very alarmed that you become depressed and give up on getting things back under control.
Of course, I don't know how well I'll do tomorrow, but as of today I know that I can still push things in the proper direction if I put my mind to it.
Although doctors are, for the most part, not thrilled by the idea of patients getting their medical information from the internet, it seems to me that the internet has given us one great benefit which never existed before: we can look things up very quickly when we need to. If we encounter a puzzling technical term, it isn't going to take us so long to find out what it means that, by the time we have the answer, we've forgotten where we saw the term in the first place.
In the old days, you might have to visit a university library and spend all afternoon there in order to figure out what the authors of a medical article were talking about. For that reason, if you picked up a research paper and found that it was full of terms which you didn't understand, you gave up on reading the thing, and put it aside forever. These days, there is no need to be intimidated into putting the paper aside. You just open up a second browser window, and let Wikipedia tell you what "glomerular filtration rates" are.
I thought of this while reading an article about a decision by the US Food and Drug Administration not to approve a new diabetes drug known as "dapagliflozin". The main reason the FDA didn't want to approve the drug was that it seems to cause a large increase in the risk of cancers of the bladder and breast. But there was more to the story than that, and understanding the story hinged on understanding a great deal of medical language unfamiliar to most of us.
I thought it might be instructive to quote some lengthy passages from the article, interspersed with explanations (in red) of terms which I gathered from looking them up on line (largely on Wikipedia).
"The US Food and Drug Administration (FDA)'s Endocrinologic and Metabolic Drugs Advisory Committee (EMDAC) today voted 9 to 6 against recommending the approval of the novel antidiabetic agent dapagliflozin (Bristol-Myers Squibb and AstraZeneca), largely because of fears that the product may cause breast and bladder cancer. The EMDAC panel was also concerned about a lack of pharmacokinetic data in the sponsors' presentation."
Pharmacokinetics is the study of what happens to a foreign substance introduced into the body (that is, how does the body process it, where does it go within the body, how does the body change it, how does the body get rid of it?). Apparently the makers of dapagliflozin didn't gather adequate answers to those questions.
"Dapagliflozin is a first-in-class medication that treats hyperglycemia through inhibition of the sodium glucose cotransporter-2 (SGLT-2) in the proximal renal tubules, where it is responsible for the reabsorption of approximately 90% of glucose filtered through the nephron."
The nephron is a small structure within the kidney (small enough that the kidney contains something like a million of them) which is used for filtering substances out of the blood and into the urine. A part of the nephron is the proximal renal tubule. The sodium glucose contransporter-2 (SGLT-2) is a transporter protein which normally drags glucose back from the proximal renal tubule into the bloodstream, and prevents it from being filtered out of the blood and into urine. By inhibiting SGLT-2, the new drug treats hyperglycemia (high blood sugar) by defeating the transport process, and causing glucose to be dumped into the bladder. This is a new approach to glycemic management; other diabetes drugs don't work this way.
"The drug's glucose-lowering ability is related to the renal excretion of glucose. The effect is dependent on the amount of glucose filtered through the glomeruli and is independent of insulin secretion."
The glomerulus (glomeruli is the plural) is a smaller part of the nephron, coming just after the proximal renal tubule. It is the part of the nephron that does the actual filtering of the blood. If the glucose is not taken back into the bloodstream by SGLT-2 in the tubule, it flows through the glomerulus and gets dumped into the urine from there. Usually, most glucose isn't dumped into urine because the tubule reabsorbs it before it gets as far as the glomerulus. If SGLT-2 is inhibited, the glucose does get as far as the glomerulus, and does get dumped into the urine.
"This method of action minimizes the risk for hypoglycemia. But it also makes dapagliflozin less effective when glomerular filtration rates decline because of the progression of renal impairment, according to FDA background materials."
Renal impairment means impairment of kidney function (which is, of course, common in people with diabetes); in patients who have that problem, the glomerulus doesn't do its filtering job as well as it should, and glucose is not dumped into the urine, or not dumped into it fast enough, no matter what the new drug is doing to make that happen. In other words, here is a diabetes treatment which works best in people who don't have diabetes, and would probably become increasingly ineffective in many diabetes patients over time.
One medical critic of the drug (Dr. Kevin McBryde) seemed to take the technical issues a bit personally: "I was quite interested in the drug because of its novel approach to the treatment of diabetes but coming at it from a nephrology perspective. I've learned in my career to have a tremendous amount of respect for the proximal tubule of the kidney. It is packed with mitochondria and it is truly a magnificent structure, and simply saying 'I'm going to block SGLT-2 and it will have no other effect on the proximal tubule,' is to give a tremendous discredit to the function of the proximal tubule." he said.
Mitochondria are tiny structures within cells which allow the body to use chemical energy; their role in keeping us alive and functional is so crucial that it is hard to imagine messing with them and not creating unintended consequences somewhere. Leaving aside the Dr. McBryde's rhapsodic celebration of the proximal tubule's magnificence, I think he's trying to tell us that a highly complex structure, packed with mitochondria, might have more jobs to do than we realize yet, and messing with it might be risky. Whether that is the reason for the elevated cancer rate I don't know, but it could be.
I could go on with this, if I had enough time this evening. Other issues of interest are introduced in the article, without any helpful explanation of what terms such as hepatotoxicity and proteinuria might mean. But it's not that hard to look up these terms as you come to them.
Anyway, when a new research paper gets some press attention, and you'd like to understand the details of it, and my blog is not offering to explain it to you, don't be afraid to explain it to yourself. The internet has given us the opportunity to arm ourselves with information of that sort.
I'm not saying that having Wikipedia in your bookmarks folder is the same thing as going to medical school, nor am I saying that you can diagnose and treat yourself reliably just by browsing medical sites. But I don't think looking up "proteinuria" to see what it means is likely to lead you astray. You're better off knowing what it means than not knowing what it means. One thing Wikipedia tends to be very good at it explaining technical terms. And if you're going to read research papers, you need to be unintimidated by technical terms. Especially as some of them are just scholarly synomyms, used by the sort of people who figure that if they refer to gaps as "lacunae" everyone will realize that they made it through graduate school!
Monday, July 18, 2011
Fasting Glucose: 100.
- Weight: 185.
Blood pressure, resting pulse: 113/76, 61.
Exercise: Gym aerobic workout; yoga class.
Aaaaack! A fasting result of 100 is not what I like to see. And the day after running a half-marathon, too!
Actually, the race was probably the reason for the higher-than-usual fasting result. The race was pretty hard on me (it seemed harder than the other half-marathon that I ran on May 22, though I couldn't say why), and I couldn't seem to drink enough water to stay ahead of the water loss from sweating. (It wasn't hot, but it was a little humid; maybe that was why I was sweating so heavily.) I was carrying a water bottle, and refilled it a couple of times at the aid stations along the way, and even so I kept running low on water, and ran out of it during the final mile of the race.
I felt very wobbly after I crossed the finish line, and when they handed me a bottle of some unidentified red drink, I downed the whole thing right away. I didn't know what it was, and to be frank I didn't care, but it tasted awfully sweet, and I'm sure it was a sugary fruit-punch concoction which I wouldn't drink under other circumstances. I felt as if I needed it at that moment, no matter what was in it, but perhaps it was a bit in excess of my actual requirements. And the rest of the day I was in a recovery phase, doing a lot of napping and lounging, and my recovery lunch and dinner were probably a bit high in carbs, considering that I was entirely at rest for the remainder of the day.
My time in the race (2:10:03) was the same as in the last half-marathon, in May -- within 9 seconds! It seems incredible that, running two different 13.1 mile races, in different locations, on different terrain, in different weather, my finish time would be the same to that degree of precision.
But the experience seemed to be different -- I was much more stiff and sore after this one. And I was sore today, too (so much so that I decided not to run at lunchtime, and do a lighter workout in the gym after work). The evening workout (and sitting in the hot tub afterward) helped, and then going to yoga class after that helped further. So I don't feel bad now, and I'm sure I'll be able to run tomorrow.
Still, the run seemed to traumatize my system, and I think my elevated glucose this morning may reflect that (at least partly; taking in too many carbs during the recovery period after the race was probably a factor as well).
I didn't manage to fit in a post-prandial test between dinner and my yoga class in the evening, but I expect that would have been higher than usual for me as well. This was just a difficult day for me.
Anyway, I think the best thing I can do now is go to bed, get plenty of sleep, and then go to work on moving my glucose numbers back down where they belong.
Friday, July 15, 2011
Fasting Glucose: 95.
Glucose 1 hour after lunch: 91.
Blood pressure, resting pulse: 120/76, 56.
Exercise: 5.2 mile run.
On Wednesday (which I called Tuesday at that time, but I think I've got things sorted out now) I was talking about the midnight-snack approach to preventing morning highs. I was saying that it doesn't work that way for me -- that eating anything late at night usually gives me a higher result the next morning, not a lower one. Just to verify what I already believed, I had a midnight snack last night, and this morning got a fasting result of 95 -- which is not actually high, but is on the high side for me. I prefer to be in the 80s. Often I can do it, but midnight snacks don't seem to help me get there. Still, it might work for you, and if it does work for you, great.
Even if you've already established in your mind that something does or doesn't work for you, it's always worth experimenting once in a while to make sure that what you've found in the past is still true. We do change over time, and heaven knows diabetes changes over time. I was wondering if maybe the midnight-snack rule had changed for me, and I ought to try it to see if it actually lowers my fasting results instead of raising them. Nope -- as far as I can see, it still doesn't work for me. But someday, if things change for me, it might be worth trying again.
Today my post-prandial result was actually lower than my fasting result. This I attribute to the tough, hilly run I did before eating. Lunch included half an ear of corn -- not one of my usual staples, but the lunch was otherwise low-carb, so I figured I could get away with a little corn this time. It turned out I was right.
Tomorrow will be a rest day, as I get myself prepared for the Napa-to-Sonoma Wine Country Half Marathon on Sunday.
The race starts at a winery in the Carneros region, which straddles southern Sonoma and Napa counties; the finish line is 13.1 miles away at the town square in Sonoma.
It's a popular event; I had to sign up for it months ago because it always sells out. Why do so many people want to run this race?
I guess a big part of it is that the race course is amongst the vineyards of the Napa and Sonoma valleys. It's very pretty territory.
People like running in a place like that on sunny summer morning. It makes you feel like you're having fun or something.
And they couldn't do it on just any sunny summer morning; running this route wouldn't really be possible if it wasn't a special event, with temporary road closures supervised by the highway patrol.
Over 3000 people are registered for this event. A surprising number of them (in fact, the majority of them) are from outside of California. Looking down the list of home cities for the runners on the list, I find such varied places as Arlington, Dallas, Seattle, Nashville, Atlanta, Washington, New York, Houston, El Paso, South Bend, Bloomington, Chicago, Las Vegas, Vancouver, Boston, Salt Lake City, Orlando, Cheyenne, Kansas City, Anchorage, Milwaukee, Portland, Denver, Whichita, Baltimore, Phoenix, St. Louis, Toledo, Virginia Beach, Tulsa, Tampa, Lexington, Charlotte, Albuquerque, Boca Raton, New Haven, New Orleans, and Philadelphia.
Pretty though the course is, it may still seem surprising that people travel such long distances to run in a race (especially one that is 13.1 miles long, and takes place in July). I assume a lot of them wanted to pay a visit to the wine country anyway, and will be hanging around for more leisurely activities afterward. Of course, an additional attraction of this one is that, after you finish the race, you get to attend a big wine-tasting event, featuring the work of the local vintners whose vineyards you have just run past.
I ran this race once before, in 2006 -- on the hottest day of the year. It was one of the tougher assignments I've ever taken on, and I'm sure I've never sweated that much in my life. I'm hopeful that things will be much easier this time. The forecast temperature for Sunday is only 70 degrees in Sonoma, and we'll be starting early, before it gets even that warm.
My modest goal for the event is to do at least a little bit better than I did in the half-marathon on May 21, where my finish time was 2:09:54. This race is less hilly, so I ought to be able to improve on that. But the real goal, of course, is to finish the race, not hurt myself, and feel good afterward (even before the wine-tasting starts).
The lesson I learned from the post-race wine-tasting in 2006 was that, when you're dehydrated from a long hard run, every wine made by anybody tastes great -- and this can lead you take a bit more wine on board than is entirely wise. I'll try to do a little more rehydrating, and a little less wine-sipping, this time around.
But I'm not making any promises.
Thursday, July 14, 2011
Fasting Glucose: 88.
Glucose 1 hour after dinner: 132.
Blood pressure, resting pulse: 115/74, 52.
Exercise: 4.6 mile run.
Yesterday, which I identified as "Tuesday", was actually Wednesday, according to a sharp-eyed reader of this blog, and I am unable to marshall any evidence to refute his view of the matter. Accordingly, I have changed the heading of yesterday's blog after the fact.
It takes a big man to admit he's wrong.
I don't have much time for blogging tonight. It's Bastille Day, after all, so after work I went to a see a couple of local bands playing French music -- as I'm sure you did, too. The show ran later than I thought it would.
I was familiar with the second of the two bands, from having heard them play before. In the case of the first band, I knew one of the musicians (the accordionist) personally. I had not been familiar with the bass player, a 22-year-old named Josh Fossgreen, whose virtuosity amazed me. I imagine he's headed for bigger things. He made a striking impression on stage, as he was extremely tall. He was also thin, which I initially attributed to the good fortune of his being young. But, upon checking out his web site after I got home, I discovered that he had weight-control problems earlier in his youth, and is thin now because he has become a raw foodist. It turns out that he runs a website devoted to that dietary movement.
The raw-food movement drives me crazy. Its advocates usually look strikingly slender and fit, and I would love to do what they are doing. But their diet is, in most cases, centered around fruit, with some vegetables thrown in for variety and vitamins, and is inevitably very high in carbohydrates. Josh's website includes some recipes which are carb-heavy beyond belief; one of them includes more than 200 grams of carbs! No matter how good the raw food diet is at helping people control their weight, it's hard to imagine how it could possibly help people control their blood sugar. For anyone with Type 2, this approach would seem to be off limits.
Yeah, yeah, I know the theory about how carbs aren't the real problem, and Type 2 diabetes patients can control both their weight and their blood sugar, once they get all that fat out of their diets. I've heard about it, but I'm not sure I can believe it. I'm not sure I can face the prospect of attempting a thing like that. My test results tell me that carbs do matter, in my case anyway. Maybe, if I threw caution to the wind, I would find that the transition to a raw-food, high-carb diet would cause my blood sugar to go up initially and then go down. But waiting for it to go down would be very, very hard on me. I don't think I can handle that!
On the other hand, my post-prandial result after dinner tonight was higher than I usually get, after what seemed to me like a pretty low-carb dinner. Seemingly it should have been lower than usual.
I have a feeling about why that happened. I'm not sure it makes sense, but here it is: shortly before I took my post-prandial test, I read a story on a news web site, about a cruel injustice which made me very angry, and I indulged that anger, letting my mind wander to other subjects that made me angry, and gradually working myself up into quite a state about all the things that are wrong with the world. It is easy to get hooked on your own adrenaline. Allowing yourself to get angry about social issues, political issues, and the general nastiness of Homo sapiens as a species can be like a hit of crack cocaine. People crave that anger. That's why we have talk radio. That's why the comments section of any web site is full of venom. It is so easy for us to get addicted to being angry. But there's a price to pay for this; anger releases stress hormones, including not only adrenaline but the very toxic one known as cortisol as well. These things have bad health effects, and one of those effects is an increase in blood sugar.
I can't prove this, but I believe it: I drove my test result up tonight by allowing myself to get mad.
Maybe I should knock it off.
My blood pressure reading, however, was taken well after my fit of internet-induced anger, so it was normal. If I had taken it at the same time as my post-prandial blood test, I'm sure it would have been considerably higher!
Wednesday, July 13, 2011
Fasting Glucose: 87.
Glucose 1 hour after lunch: 109.
Blood pressure, resting pulse: 113/72, 67.
Exercise: 4 mile run at lunchtime; weight-lifting in the evening.
I forced myself -- against strong opposition from said self -- to go down to the gym tonight and do some strength-training. Maybe I need to do some kind of deep psychological exploration of my subconscious mind to find out why I am so resistant to resistance training. Why do I find it so much harder to visit the weight room than to visit the jogging trail? The first answer that springs to mind is that working out with weights is hard, and it kind of hurts, and I'm not very good at it, and it might injure me. All valid objections, of course -- but they apply equally well to running, and I do that all the time. Maybe the problem is lack of peer pressure: I have running buddies but I don't have weight-lifting buddies, so there's no social pressure keeping me reinforced in the habit.
I have absolutely no excuse for my bad attitude about lifting weights. I've seen enough research results to know that an exercise program works best (and not just for diabetes patients) if it includes weight-lifting. Aerobic exercise is important too, of course, but it's not quite the whole story.
Tonight my blood pressure is lower than yesterday, but my pulse is higher than yesterday. For whatever reason, this is what I usually find on a day when I've lifted weights.
A reader of this blog had told me, a while back, about his struggle to get his fasting level back down to where he used to be able to maintain it. Lately it had been slightly elevated -- and persistently so, no matter how much he exercised and no matter how much he restricted his carb intake. His system seemed to be predisposed to have a slightly high fasting result. The Dawn Phenomenon had taken charge, and was unwilling to go away.
At the time I was unable to give him any very useful advice, because it seemed to me that he was already doing all the right things. I completely forgot to mention one thing which a lot of people do to combat the Dawn Phenomenon. Well, now he's discovered that technique himself, by accident: if he has a snack before going to bed, his fasting result is lower the next day. He's experimented with this enough to establish that it really does work for him.
I feel a bit embarrassed not to have thought of suggesting this idea to him earlier. It's not as if I'd never heard of it. I simply forgot all about it when I was writing back to him.
Sometimes I have a blind spot about a diabetes-related matter, mainly because it isn't relevant to my own situation. If I've tried a particular remedy and found that it doesn't work for me, I tend to dismiss it from my mind, and I forget that it might work for other people, even if it doesn't work for me.
Usually, my fasting result is lower if the fast was longer. A midnight snack gives me a higher fasting result the next day, not a lower one. This is not always true; if I go to bed hungry, expecting that my fasting result will be exceptionally low in the morning, I am sometimes disappointed to find that it is actually a bit high. But that is definitely the exception rather than the rule. My fasting result is usually lowest if I eat nothing between dinner and bedtime.
However, what's true of me is not true of everyone. For at least some people (and maybe even for the majority of people), a midnight snack is likelier to prevent an elevated fasting result than to bring it on. I shouldn't forget that, just because it isn't useful to me personally.
The actual mechanics of the Dawn Phenomenon are not so well understood that we can generalize about what everyone with diabetes should do about it. Unless you spend a week or two at the Mayo Clinic, having your glucose and insulin and glucagon continuously monitored under different conditions, I don't think you're ever likely to find out exactly what is the best approach for you to take to this issue.
And, of course, there are other layers of mystery involved here. Even if the midnight-snack approach is effective in your case, is it worth it? Do you come out ahead on the deal, in terms of total exposure to blood-borne glucose over time? It is possible that the midnight snack gives you a lower fasting result when you wake up, but also gives you elevated blood sugar during much of the time that you're asleep, so you would need to gather a lot of data to be sure that the midnight snack was more helpful than harmful overall.
However, since most of us can't collect that kind of data on ourselves, we have to work with the data we've actually got. If your fasting result is going to be one of the most important pieces of data you'll be confronted with on a daily basis, there are important psychological advantages in getting that under control. If it's not in control, you are likely to feel frustrated, helpless, and even depressed. That way lies danger -- specifically the danger of burning out and giving up. Perhaps it is better, overall, to use midnight snacks -- or whatever else works for you -- to get your fasting result where you want it, even if there would theoretically be a small advantage in doing something different.
Type 2 diabetes is a
mysterious and complicated disease (or family of diseases), and what works for
one person won't work for another. I'm naturally timid about recommending
anything which doesn't work for me, even if I have heard that it can work for
some people. In fact, if it doesn't work for me, I tend to forget about it
entirely. I guess the moral here is not to take suggestions about diabetes
management from any one source. There are a million ideas out there about how to
manage diabetes, and some of them will work for you. But you may have to try a
lot of things before you discover the ones that do work for you. The fact that I
see no value in a particular approach does not mean that it will definitely have
no value for you.
Tuesday, July 12, 2011
Fasting Glucose: 93.
Glucose 1 hour after lunch: 117.
Blood pressure, resting pulse: 122/75, 51.
Exercise: 5.4 mile run.
I wanted to do a tougher-than-usual run today, because I knew I would be having an Ale Night with some work friends, and I figured I should earn it. None of my running buddies were available to me today; I chose a super-hilly route that they all hate and would not want to do, if I suggested it to them. It's a killer of a workout. I felt good afterward -- but also very hungry. That's one of the problems with looking at exercise as a weight-loss method: the number of extra calories it burns is usually less than the number of extra calories it inspires you to consume. At least the run prevented my post-prandial test result from going too high (even though the lunch I ate after running was higher in carbs than usual).
Someone was referred by Google to my website after they entered the search phrase "what type 2 diabetes says about you".
Kind of an interesting question. One answer would be, "that you're a form of animal life". Type 2 diabetes, or something like it, occurs in other animals, including dogs, cats, turtles, lizards, and birds. Although the disease is claimed to have a lower incidence in these animals than in humans (perhaps 1 in 400 for cats), I have a hard time believing that. I know too many people who have diabetic cats for that 1-in-400 rate to seem at all plausible to me. In any case, the incidence is said to be rising in pets as it is in humans, so perhaps the quoted figures are outdated.
I cannot find any references to plants with diabetes, so I assume the disease is specific to the animal kingdom, and if you have the disease, you are almost certainly an animal.
Beyond that, it would be hard to say with any confidence what type diabetes "says about you". So far we don't even have a very clear idea of what type 2 diabetes is; as I've said before, we certainly don't know, and have little reason to suspect, that it is a single disease with a single cause. We know some of what is involved (genetic factors, lifestyle factors, diminished insulin resistance, diminished insulin production), and we know a lot about what happens if you don't manage the condition well (don't ask), but most of the facts we have gathered about the disease are applicable in some cases and not others. Are type 2 patients fat and sedentary? Often, but not always. Does the disease have a genetic basis? Seemingly yes, but the number of different genes associated with an increased risk of diabetes is almost suspiciously lengthy, and it appears that these genes often, but not always, need to be aided and abetted by unfavorable lifestyle choices in order to cause the disease.
But we all know (don't we?) at least one person with type 2 diabetes who does not fit the profile. Active, slender people with no known family history of diabetes who are caught entirely by surprise by a diabetes diagnosis.
Although some people will be quick to jump to certain conclusions about people with type 2 diabetes (and will not always be wrong), the nature of the disease is so elusive and complex that it is best not to speak of it in such broad, categorical terms. If you have type 2 diabetes, then you are not a plant. Farther than that it is probably unwise to go.
Meanwhile: some recent horoscopes from The Onion:
Monday, July 11, 2011
Fasting Glucose: 93.
Glucose 1 hour after lunch: 105.
Blood pressure, resting pulse: 120/72, 51.
Exercise: 4 mile run at lunch; yoga class in the evening.
I took some time off work last week, but I didn't do anything especially dramatic with the free days. I was just doing my best to relax, and I dabbled in various leisure activities: hiking, music-making, wine-tasting, and visiting with friends and family. I did continue exercising, of course (including an 8.5 mile trail-run yesterday).
I also did a few experiments on the subject of Getting Some Perspective. I've heard that one way to deal with work stress is to imagine looking at your workplace from the moon, and noticing how small it is compared to the rest of the world. I have trouble implementing that idea, but there is a similar one that I can use. My workplace is visible -- distantly -- from various places where I run regularly. One of them is a short, exposed section of the Cobblestone Trail in Annadel State Park. From that trail (which I ran yesterday) I took a few snapshots of the view. Here's the wide-angle view, showing where my workplace is, even though you can't really spot it in this image.
Zooming in reveals a glimpse of the red tile roof of the building in which I work:
I don't know that this kind of exercise really does much to combat job stress, but every little bit helps. The run probably helped more.
Okay, so now we need to talk about...
It seems that HDL ("Good Cholesterol") cannot be counted on to remain good, at least according to this Medscape article.
According to some kidney experts currently meeting in Prague, circumstances can transform HDL into a substance which does more harm than good to the coronary arteries. The particular circumstance they have in mind is CKD (chronic kidney disease), but they throw in a few offhand remarks suggesting that diabetes might be able to do the same trick.
Most of us probably think of cholesterol as a dissolved substance, thoroughly mixed into the blood, but it seems that it actually circulates as "particles" -- little globules of cholesterol which float around in the bloodstream, occasionally interacting with the "endothelium" (the interior lining of the arteries). The nature of those interactions between cholesterol particles and the endothelium is crucial to your cardiac health.
The legend we are usually given is that LDL particles are the villain of the story (depositing harmful crud on the endothelium, which builds up and eventually blocks the flow of blood through the artery), while HDL particles are the White Night which rides in to the rescue, peels that crud off the endothelium, and keeps you safe. Most people have less HDL than LDL, but when HDL is heavily outnumbered, your heart-attack risk goes up. So: more HDL is better.
Apparently there is more to it than that. HDL doesn't just haul away whatever trash has piled up on the endothelium; it also interacts directly with the endothelium, and one of its effects is to reduce inflammation (which is good, of course -- inflammation stresses the body in various ways, makes diabetes worse, and sets you up for heart disease, so anything that reduces inflammation is probably a step in the right direction).
However! It seems that HDL, the White Night in the tale, can be corrupted. In people with chronic kidney disease (I was afraid you might not remember what CKD stood for), HDL takes on a different form, and this form of HDL promotes inflammation instead of reducing it! In people with CKD, raising HDL might not be helpful, since HDL in such patients takes on a form which makes the situation worse rather than better.
Worst of all (at least from my perspective as someone who has been diagnosed with diabetes but not with CKD), HDL may also take on a harmful form in diabetes patients! I gather this from one brief aside in an article which is really about CKD rather than diabetes, and I don't want to make too much of it. But it appears that at least some of the harmful effect which CKD has on HDL can also be produced by diabetes.
I need to step carefully here; I don't want
to be an alarmist. But if there is any possibility that raising your HDL is
harmful rather than helpful if you have diabetes, we need to find out a lot more
about that! I hope someone is going to look into the matter more thoroughly.
Conceivably, this finding is nothing more than confirmation that CKD is common
among diabetes patients; if that's all that's going on, I'm not too worried. But
diabetes has a harmful effect on HDL, even in patients whose kidneys are fine,
we need to know more about that!
July 5-11, 2011
I'm going to take some time off blogging -- I expect to be back on July 11.
Monday, July 4, 2011
Fasting Glucose: 84.
Glucose 1 hour after dinner: 106.
Blood pressure, resting pulse: 112/74, 56.
Exercise: 10K footrace.
I began Independence Day the way I usually do: running in the Kenwood Footrace, which is 10 kilometers (a little over 6 miles) of hilly racing amongst the vineyards of the Sonoma Valley. It's a very pretty course -- but also a very challenging one, because of all the climbs.
I forgot to bring my Garmin GPS device with me to the race. I usually use that device to keep track of my pace. It was what enabled me to finish the half-marathon on May 22 within my target time; I kept checking on my pace as I went along, and that kept me from slowing down without being conscious of it. Would I be slower today, without an electronic gizmo to keep me on track?
Why, yes, as a matter of fact! I was slower than last year by more than a minute. I thought I was going faster, I guess because I felt good. (And I guess I felt good because I wasn't really going faster.) My heart sank as I approached the finish line, and saw the timer display, and realized that this was going to be my worst performance ever in this race, not my best. I finished in 1:02:50, which was more than a minute slower than last year. My mile pace (10:08) was not only slower than last year, it was also slower than my pace in the half-marathon (9:55). Because today's race was so much shorter than the half-marathon, I should have been able to maintain a faster average pace during it, even though the hills were steeper.
In theory, I should have been able to maintain a pace of 9:31 in today's race, because I did that once before. I was six years younger then, but that excuse carries me only so far; one of the guys who finished ahead of me today is 74 years old. (He enters local races all the time, and he usually has little difficulty in humbling me.) The crowd favorite, though, was a guy who was in the shorter race (a 3K); his pace was far slower than mine, but people felt like they should cut him a little slack because he's 91. Of course, if there's any participant in today's race that I should be emulating, it's him. Staying power is mainly what this is about.
Rather than dealing with the parking/traffic challenges of going to see the local fireworks at close range, I simply walked to the top of a hill in the neighborhood that overlooked (pretty distantly) the county fairgrounds from which the rockets would be launched. I set up my camera on a tripod to steady it, and waited for the show to start.
I really was too far away for the show to have the kind of impact it should have had, but for once in my life, I actually got some good shots of the fireworks.
A tripod makes a difference in a lot of situations, but never more so than when you're trying to photorgraph a fireworks display.
But, as so often happens, I had to make a choice between photographing the event and experiencing the event. I wasn't watching fireworks, like all the other people standing on that hilltop; I was working hard at the task of capturing photographs of the fireworks. Maybe next year I should just go and see the fireworks. Lots of people do that and seem to find it satisfying.
Friday, July 1, 2011
Fasting Glucose: 83.
Glucose 1 hour after dinner: 129.
Glucose 2 hours after dinner: 96.
Blood pressure, resting pulse: 102/67, 64.
Exercise: Gym aerobic workout (stair-climber).
My schedule was a little disrupted today, and I couldn't run at lunchtime. I had a pretty light lunch (a bowl of soup), and as a result I was feeling hungry by the time I did get a chance to exercise, after work. I didn't want to eat before exercising, so I did my workout while I was hungry. So, by the time I got home to eat something, I was feeling extremely hungry, and perhaps hypoglycemic.
I simply felt as if I had pushed my system too hard. Maybe there was a reaction, and that was why my post-prandial result (after a moderate-carb dinner) was 129, which isn't actually bad -- but is higher than I thought it would be. I decided to check again at the 2-hour point to see if anything odd was going on; it was down to 96 by then.
This business of coordinating your exercise schedule with your eating schedule can be mighty hard to get right. I know that exercising soon after eating usually makes me feel terrible; I also know that exercising way too long after eating can make me feel terrible in a different way, and possibly give me some kind of an overcompensation reaction.
But there's a limit to how much we can control our daily schedules; often a workout needs to be slipped into the only timeslot we can make available for it, regardless of how poorly that timeslot matches up with our opportunities to eat that day.
I guess there's a limit to how strictly you can manage your diabetes and still participate in life. We all have to find a compromise we can live with; I imagine my own particular compromise to be stricter than average, though.
Some British scientists claim to have figured out how the human brain processes jokes. They used "fMRI" (functional Magnetic Resonance Imaging) to study the brains of volunteers while telling them jokes. This enabled them to study activation of different areas of the brain -- and to determine that jokes involving puns tended to activate the brain areas devoted to language processing more than did jokes not involving wordplay.
A suggested practical application of this is to scan the brains of patients in a vegetative state, while their relatives tell them jokes, to determine whether or not such patients are able to experience positive emotions.
However, only one actual joke was quoted in the report I read on this research, and here it is: "Why don't cannibals eat clowns? Because they taste funny!"
Unless the other jokes used by the researchers in their study rose considerably above the humor standard set by that particular joke, I think it is quite possible that what the researchers really discoverd was the brain's centers for wincing and grimacing.
Although I'm no supporter of the idea of keeping patients alive in a permanent vegetative state, I would hate to have the definition of "vegetative state" become "unable to take pleasure in the feeblest pun known to British medical science".
Try this again with something funny, gentlemen!
"NOT MEDICATED YET"
Reading the Stats
What this is about
I am going to use this space to report on my daily process of staying healthy -- what I'm doing, and what results I'm getting, and how I interpret the connection between the two.
I am not trying to taunt anybody, by reporting better results than they are getting themselves. I'm doing this to provide encouragement, not irritation.
Regardless of what your own health situation is now, you can probably pick up some useful ideas by tracking what I'm doing, and seeing what the results are. I don't mean that you should do whatever I do, or that imitating my behavior will get you the same results I get. We all have to figure out what works for us. Let's just say that I'm giving you an example of some things to try, and they might help. If they don't, try something else!
One word of warning: I sometimes participate in endurance sporting events (including "century" bike rides and the occasional marathon), but please don't assume that you would have to participate in extreme sports to get the kind of results I'm getting. Most of the year I'm not working out nearly that hard, and I still get very good results. For some people, vigorous walking may be enough. (But if it isn't in your case, don't cling to the idea that it ought to be enough -- do whatever it takes to get good results!)