Fifth Thursday Update
Thursday, May 29, 2014
Fasting Glucose: 86 mg/dl.
Glucose 1 hour after lunch: 110 mg/dl.
Weight: 195 pounds.
Blood pressure, resting pulse: 117/74 mmHg, 56 bpm.
Exercise: 5.4 mile run.
People like to turn to search engines for answers to their diabetes questions; let me volunteer to answer some of the more interesting ones that have been logged this month.
"can an a1c level of 8.5 cause vision problems"
Yes, but we need to distinguish between the short-term vision problems it can cause and the long-term vision problems it can cause.
A hemoglobin A1c level of 8.5% translates, in the average person, to an average blood sugar in the vicinity of 197 mg/dl. If that's your average, then presumably you're often higher than that.
As it happens, having high blood sugar can have a short-term, temporary consequence of blurred vision. Exactly how high your blood sugar has to get before your vision gets blurry is hard to say (the research I've been able to find has been quite unclear on this point, and probably it varies from person to person.) But it may well be that a level of 197 mg/dl or higher could do it.
The reason for the blurred vision is interesting. The lens of the eye is permeable to glucose -- unlike most other body tissues, the lens absorbs glucose readily without needing any insulin stimulus. Therefore, when your blood sugar is high, the lens absorbs glucose until it has the same glucose concentration as your blood. However! Once the glucose is inside the lens, an enzyme turns it into a sugar-alcohol called sorbitol. Soon the lens is saturated with sorbitol. Since the bloodstream is not saturated with sorbitol, this difference in concentrations creates "osmotic pressure", and the lens begins absorbing water to reduce the sorbitol concentration. This absorption of water causes swelling of the lens, and the swollen lens can no longer be compressed enough by the focusing muscles to yield a clear image.
This blurred vision, caused by swollen lenses, is a temporary effect, but that doesn't mean it goes away as soon as blood sugar is normalized. The swelling of the lenses can persist after the original cause of the swelling has been removed. How long it can persist is unclear, at least to me, because the research paper I read on the subject was pretty confusing on this point -- but the case history quoted in the paper made it appear that the problem persisted for about a day.
In the long term, elevated blood sugar of the sort we're discussing here can cause problems of a more serious and permanent nature -- particularly retinopathy, a condition in which the tiny blood vessels in the retina of the eye are damaged, resulting in progressive loss of vision.
Anyway, an A1c level of 8.5% is too high and does increase your risk of vision problems, sooner or later.
"11% h1ac equals how much"
Too freaking much, that's how much. An A1c result of 11% is believed to be equivalent -- in the average patient -- to an average blood sugar level of 269 mg/dl. If you stay that high over a period of years, the risk of vision loss due to retinopathy rises to something like a certainty.
"i seldom take sweet thing: y my sugar is quite hi"
Maybe you seldom take sweet thing, but do you often take starchy thing?
Most people don't think of cereal, bread, rice, potatoes, or pasta as sugary, because they don't taste sweet. But they're made of starch, and starch is made of sugar. Specifically, starch is made of sugar molecules chained together in such a way that they don't stimulate sugar-sensitive taste buds. This makes us think of sugar and starch as two vastly different things. The distinction between them is largely meaningless, unfortunately. Starches are just chains of sugars, and when you digest them they break up (within minutes!) into their component sugars.
On nutritional labels, do not be mislead by the number given for "sugars", which is sometimes far lower than the carbohydrate total. The "sugars" figure omits the starch, which is really just sugar traveling under an alias. The food industry would like you to think that starches are not sugars, but if they turn into sugars when you swallow them, what's the difference?
"diabetic keep peeing suguar levels are in the ones whats going on "
Sugar (or anything else in the blood which shouldn't pass into the urine) begins to pass into the urine whenever the concentration of that substance in the blood gets higher than the "renal threshold" for that substance. That is, once the concentration of that substance is high enough, it overwhelms the kidney's filtering capacity and the substance starts to transfer itself from the blood to the urine. The renal threshold for glucose is somewhere around 160 to 180 mg/dl, but it varies from person to person, and it seems to be lower (as low as 126 mg/dl) for pregnant women and children. (I don't mean the children are pregnant, just the women. English is a tricky language.)
Anyway, if by "sugar levels in the ones" you mean sugar levels below 200 mg/dl, those level are not low enough to guarantee that you won't excrete sugar in the urine.
"when your sugar is low does it make u urine alot"
Not that I've heard. You're thinking of the effect of high blood sugar. It's another effect of "osmotic pressure", but this time impacting the kidneys rather than the eyes. When a lot of sugar passes through your kidneys into the urine, a lot of water flows with it.
"my glucose level is 111 at night but ac1 test 6.4%"
An A1c test result of 6.4% is believed to equate, in the average patient, to an average blood sugar level of 137 mg/dl. This is not necessarily inconsistent with a night-time test result of 111 mg/dl, since your blood sugar is certainly going to be higher than 111 at various other times of day.
"how low does your sugar have to get to kill you"
"will low blood sugar kills"
"what low blood sugar level will kill you"
"what is the dangerous suger level that can kill"
"how can low blood sugar kill you"
Calm down, people. Surprisingly few people actually die from hypoglycemia (low blood sugar). Hypoglycemia is usually just very unpleasant. However, if it gets severe enough, hypoglycemia it can become life-threatening because of the potential impairment of heart function and brain function.
Also, even if hypoglycemia doesn't kill you directly, it's stressful on the heart, brain, and body to go through frequent severe hypoglycemic episodes, and having a lot of those episodes could damage your health and ultimately shorten your life, even if not one of those episodes ever gets listed as the cause of your death.
Anything below 50 mg/dl probably damages some brain cells, anything below 40 mg/dl may result in loss of consciousness (which could result in a car crash or other accident), and anything below 30 mg/dl has the potential to be life-threatening.
I know people who have survived excursions into the low 20s without obvious lasting harm, but that doesn't mean that's a safe place to be. One of the risks that has to be considered, in evaluating the safety of any diabetes drug, is how high a risk it presents of frequent severe hypoglycemic episodes.
"urine attract ants but not diabetic"
There is no accounting for taste.
The diagnostic technology for diabetes has improved since the Bronze Age, folks. Forget the damned ants; get a meter.
"why does it feel like my blood sugar gets low when i weld alot"
Perhaps because your blood sugar does get low when you weld a lot?
Get a meter, do some testing, and see if your blood sugar actually does get low when you think it does. I don't know of a direct link between welding and hypoglycemia, but who knows?
"how does insulin keep blood cells from being glycated"
It doesn't, directly. But the glycation rate of blood cells is determined by average blood sugar, and using insulin regularly is one way of reducing average blood sugar.
"if you dont have diebeties but sugar shows up in your urine whats wrong "
"i had sugar in my urine does that mean i'm diabetic"
Sugar in the urine doesn't always mean diabetes, but it typically does. Unfortunately, if sugar in the urine is not being caused by diabetes, it is probably being caused by something equally serious, such as kidney disease.
Sugar in the urine is a worrisome symptom no matter what is causing it, and it needs to be checked out by your doctor.
Anyway, most people who say they have sugar in the urine but don't have diabetes are people who have diabetes but don't yet know it.
"if blood oressyre fir femal over 50 falls to 106/68 cause fie akarm"
Having that much trouble spelling is certainly cause for alarm, no matter what is causing the problem.
"people who don't have no clothes on"
All right, you folks at Google -- stop sending these people to my site! There's nothing to see here, folks. Move along.
Fourth Thursday Update
Thursday, May 22, 2014
Fasting Glucose: 97 mg/dl.
Glucose 1 hour after lunch: 101 mg/dl.
Weight: 196 pounds.
Blood pressure, resting pulse: 117/68 mmHg, 57 bpm.
Exercise: 5.4 mile run.
Lately my fasting tests have been drifting upward, even though my post-prandial results have generally been good. I hoped and expected that my fasting test would be lower than 97 today. I reacted to the disappointment by resolving to have a low-carb lunch, and that (combined with a tough hilly run before the meal) gave me a low post-prandial result. But I want to get my fasting results back to the 80s, which is where I feel comfortable having them if I can make it happen. Getting more sleep would probably help, and I'm trying to make that happen, too.
Scientists at the University of Texas are deliberately producing mutant mice. Perhaps that doesn't sound like the wisest possible course of action. What if they hybridize mice with fire-ants, and the creatures escape the lab? Are Texans ready to cope with the Lone Star State being taken over by venomous rodents? (Perhaps I'm asking that naively, not having lived under their state government myself.) I don't think the scenario I'm suggesting here is at all likely... but still, hearing that scientists are creating mutant mice is bound to make the casual observer wonder what good could possibly come of such weird experimentation.
Well, the short answer is that the best way to find out how something works (in biology, that is) is to break it, and see what happens when some part of it is not working.
This is particularly true of neurology: so much of what is known about how the brain works was discovered by studying people who (owing to damage caused by a tumor, stroke, or trauma), had brains which were not working quite right. For example, senses other than the famous "five" are only known about because, every once in a while, they fail. We know that there is a sense of "proprioception" (which enables us to distinguish between what is part of our body and what is not) because in rare cases it malfunctions, and a patient becomes convinced that one of his legs isn't his own. If that sense never failed, it probably wouldn't even occur to us to think that there was a brain function needed for this purpose. Because it does fail now and then, scientists can study how it works, and what part of the brain is in charge of it, by studying patients who have a problem with it.
A lot of what biologists know about what genes do, and what role is played by the proteins those genes code for, is learned by studying mutations in particular genes, to find out what the consequences are of having that mutation.
Studying mutations by waiting around for them to occur at random is not usually very practical, so the Texas scientists have been inducing mutations in mice deliberately. And their latest breakthrough is a mutation on the Samd4 gene, which produces a type of mouse they describe as a "supermodel". That is, it's a naturally thin mouse. The supermodel mice don't gain weight, even if they are inactive. They have an unusual fat distribution in which "brown" (energy-burning) fat predominates. They burn a lot of calories just lying around.
I had hoped that the article on the research would supply photos of the supermodel mouse, but to my great disappointment, the only photos are of the researchers themselves.
They seem like pleasant enough guys (at least if you don't look at them from the mouse's viewpoint), and the fellow on the left (Bruce Beutler) won a Nobel prize three years ago, so he probably has a pretty good idea what he's doing. But they weren't what I wanted to see. I turned to Google to search for images of "supermodel mice". I did find one, but something tells me this isn't what the researchers were studying:
So, I guess I'll just have to take their word for it that they have produced the type of mice that the designers of mouse clothing dream of working with. Anyway, why does any of this matter?
Well, the issue is that the Samd4 gene produces a protein which plays a hitherto-unknown role in regulating metabolism, energy consumption, and fat distribution. The mutation throws all this off. One result is that the supermodel mice tend to have a diminished insulin response to glucose intake -- that is, they produce less insulin, for a given amount of glucose entering the bloodstream, than other mice do. That would explain the thinness of the supermodel mice, I guess. Absorption of glucose by cells, and conversion of it into fat, is a process driven by insulin. (No insulin, no fat storage.) If you stop producing insulin entirely, you lose weight rapidly; that is why Type 1 diabetes, which kills off insulin-producing beta cells, is typically recognized by the rapid weight-loss it causes.
Although the drop in insulin productivity caused by the Samd4 gene mutation is not as dramatic as the near-total shutdown caused by Type 1 diabetes, it's apparently enough to result in thin mice. Whether it's enough to result in diabetic mice is not clear from the research report. But I mention the possibility because I don't want to create the impression that this research is necessarily going to result in a safe and effective medical treatment which can turn us all into supermodels. Maybe that genetic mutation has effects other than making you thin. We'd better do a pretty thorough quality-of-life analysis, to find out if being a supermodel mouse is really worth it. (And while we're at it, we might want to ask the same question about supermodels of the Homo sapiens variety.)
The Samd4 gene has received little attention up to now, but it is known to play a role in regulating other biological processes, including the death and recycling of cells. It would not be astonishing if it turned out that any therapy which messes with the Samd4 gene will have unintended consequences in other areas. Researchers would have to work pretty hard at convincing the world that a treatment based on manipulating that gene (or the protein it codes for) is safe.
However, it does seem obvious that researching this genetic mutation could teach us a lot about metabolism and about metabolic disorders.
I think we're going to have to be pretty patient with this kind of research; it will probably be a long time before it yields much in the way of useful information (let alone safe and effective therapies). But it will be worth keeping an eye on this research. Especially if they finally give up some pictures of the supermodel mice.
Third Thursday Update
Thursday, May 15, 2014
Fasting Glucose: 95 mg/dl.
Glucose 1 hour after dinner: 120 mg/dl.
Weight: 195 pounds.
Blood pressure, resting pulse: 106/66 mmHg, 64 bpm.
Exercise: 5.3 mile trail-run.
My meeting schedule at work today made my usual lunchtime run impractical, but there's enough daylight left after work these days for an evening trail-run at the state park -- so I did that. And I was glad I did, because it was beautiful in there in the late-afternoon light. The meadows still have some green in them from the recent rains, even though it's heating up now, and there are colorful wildflowers everywhere. The wildlife was limited to squirrels, wild turkeys, and lizards. No rattlers, no mountain-lions. What more could I ask for?
Here There Be Correlations!
We've all seen them: the graphs which show that one trend is tracking another, and invite us to assume that one is causing the other. People trying to convince us that they've identified the cause of a health problem or a social problem love to show us graphs that match up a rising rate of juvenile crime with increasing sales of video games, or a rising rate of disease with a rising rate of consumption of asparagus. (Actually, I'm kidding about that last one -- asparagus isn't the sort of food that would be blamed for an increase in disease prevalence.)
For example, here's a graph which shows the increasing share of sugar consumption that comes in the form of High Fructose Corn Syrup (the red bars represent HFCS) -- and superimposed on top of that, we see the steep upward arc of the rate of severe diabetic kidney disease!
Now, a hyper-suspicious person like me might notice that the kidney disease rate tracks HFCS consumption pretty closely from 1980 to 1990, and then diverges from it pretty widely after 1990. If HFCS is causing diabetic kidney disease, why don't they stay in better step after 1990? But that's just me. Most people would look at that graph and say, by golly, this proves it: HFCS is destroying America's kidneys!
But that's the trouble with correlations: the mere fact than one thing increases or decreases when another thing does is not anywhere close to proof of a causal connection between them. People understand this if they think about it, but often they don't think about it, because whatever graph they were shown looked so compelling.
A law student named Tyler Vigen has decided to clarify the issue by creating a website devoted to spurious correlations. He shows graphs of trends that correlate closely even though it's impossible to see how the two trends could have anything to do with one another.
For example, here's the divorce rate in Maine since the year 2000 -- plotted against margarine consumption. Mere coincidence, you say? Ha!
Or consider the way the U.S. government's science budget is clearly driving the rate at which people hang themselves:
And don't get me started on how cheese consumption results in people suffering accidental death by means of bedsheet entanglement (apparently a more common problem than I would have thought, at least among small children):
It's easy to laugh off these examples, because they were obviously selected to highlight odd coincidences which suggest connections between clearly unconnected things. But when the two trends being compared seem as if they could be related, it's awfully tempting to assume that the graph is all we need to prove that one thing caused the other.
That's one reason to reserve judgment about the meaning of a correlation study. Another reason, which we wouldn't have to worry about in an honest world, is that sometimes the person constructing the graph has not been very careful about insuring that both trends are accurately represented by the numbers given.
A startling example of this came to my attention today, because of researchers taking a second look at the Danish research from the 1970s which started the fish-oil supplement craze.
The Danish researchers (one of whom was named H.O. Bang, which should have been enough to put us on our guard right there) seem to have been influenced by romantic notions of the Nobel Savage. A lot of people like to assume that people living a traditional life in primitive conditions are more in tune with nature, and hence more naturally healthy, than we are. The Danish researchers decided to investigate the question of why the Inuit people of Greenland had a lower rate of heart disease than people leading a more urbanized, modern lifestyle. They concluded that the Inuit diet -- rich in fish oil -- was having a protective effect, and preventing heart disease. Obviously, modern urbanites should take fish oil supplements, so that they can have the same kind of protection from heart disease.
What the researchers didn't do was measure the actual rate of heart disease among the Inuit people; they took it for granted that public health records were adequate to assess this. Based on their credulous approach to questionable data, a fish-oil supplement industry was born (or at least greatly rejuvenated).
Researchers taking a second look at all this have concluded that the Inuit only appeared to have a reduced rate of heart disease, because they were very poor people living in very remote areas, and had little contact with medical care of any sort. The public health records of the 1970s simply did not have enough data on their health to reach any conclusion about their rate of heart disease. And more modern studies that have looked directly at the health of the Inuit people find that (1) their rate of heart disease is not unusually low, and (2) their rate of stroke is high. The whole foundation for the fish-oil supplement craze consisted of a false correlation that arose because bad data was fed into a graph.
I am not claiming here that all correlations are meaningless (even when the data is good), but a great many of them are, and we should try not to forget that. When Tyler Vigen digs through statistics looking for correlations, he is looking specifically for correlations that are strikingly absurd. But when most searchers dig through statistics, they are looking for correlations that (1) are not strikingly absurd, and (2) tend to confirm what they would like to believe is true.
I have tried out a lot of things (including fish-oil supplements!) which correlation studies have suggested would be helpful, and I have usually abandoned them because I couldn't see that they were making a difference for me.
In terms of issues such as glycemic control, which can be tracked on a day-to-day basis, it is fairly easy (at least for anybody who is taking notes and watching trends) to find out whether something works or doesn't work. In terms of issues such as cardiac risk, which cannot be tracked on a day-to-day basis, we often have to make an educated guess about the truthfulness of a correlation study. But it's always worth keeping track of subsequent studies, to see if we really need to keep swallowing fish-oil supplements and tolerating the creepy aftertaste. And apparently we don't, which I for one am ready to categorize as good news!
Second Thursday Update
Thursday, May 8, 2014
Fasting Glucose: 103 mg/dl.
Glucose 1 hour after lunch: 119 mg/dl.
Weight: 195 pounds.
Blood pressure, resting pulse: 120/71 mmHg, 55 bpm.
Exercise: 5.4 miles.
Damn, I don't like getting fasting results over 100. And this morning I was about to cry foul and say that it wasn't fair, that I hadn't had that many carbs yesterday. But then, looking back over it, I realized that I actually had... but had conveniently forgot about it. So, I tried to do better today. I did a hard run at lunchtime, and had a pretty low-carb lunch, with the result that I got a pretty low post-prandial result.
A lot of people (including a lot of people with medical degrees) think it isn't really necessary for people with Type 2 diabetes (or at least people whose Type 2 diabetes is well-controlled) to keep on doing regular glucose testing. They think this because they haven't tried to manage Type 2 diabetes themselves. Our capacity to fool ourselves into thinking we're not taking in as many carbs as we really are is practically limitless, and we never get past the point where we need to be kept on track. It doesn't matter that we "already know what to do". If we don't keep testing, so that we get an immediate warning whenever we start to drift off course, we drift very far off course. That's just how it works. We need those regular reality checks. If we don't get them, we fool ourselves into thinking everything is going fine when it isn't. And by the time we realize things aren't fine, we may have a very hard time getting back on course.
Regular testing: there just isn't any substitute for it.
The eyes (don't) have it
Not everything you read on the internet is true. Just today I found out that there actually isn't actually a new movie out (based on a Stephen King novel) called Stove Wolf. That was just a joke.
But I do see a lot of announcements about health research on the internet, and some of them might be both true and important. The trick is finding out whether they are either of those things. For example, is it true that coffee presents eye diseases of the sort associated with diabetes?
Today I went to the eye doctor for my annual eye exam. My eye doctor asked his annual question about whether I'm "still" controlling my diabetes without medication, and I gave him my annual answer that, yes, I am. But a lot of other stuff had already happened by this point.
Health professionals basically have no understanding of what the people who come to their offices are going through on these occasions. For them, it's just another hour of the workday to get through. For us, it's a moment of high drama: is this the day I find out it's all coming apart for me? I tell myself that I've got things basically under control, but I could be living in a fool's paradise -- and if I am, this could be the day I find it out.
Whatever information we receive today, about what the examination shows or our test results show, could be life-changing news for us, equivalent (at least) to being notified that we have won the state lottery, or have been drafted into the army, or have won the Nobel prize, or are losing our jobs, or are being transferred to the regional office in Cairo. Doctors and nurses have no clue about this theatrical aspect to our encounters with them. That is why they can't understand why our blood pressure might go up on these occasion. Why would anyone stress out just because he thinks his fate is about to be decided, or he is about to subjected to some medical humiliation or other?
The eye doctor's assistant had escorted me into a side room for some testing, including the dreaded glaucoma test, in which the fluid pressure inside your eyeball is tested by a machine which opposes that pressure by hitting your eyeball with a shock wave of compressed air, to see how much the eyeball yields to the impact. No, it doesn't hurt -- it just makes you jump out of your skin when it happens, which I at least find extremely embarrassing. And then they do it to the other eye, and you tell yourself you won't jump as much on this one, and of course you jump more.
Then there's the retinal scan, in which you try to keep your eyes wide open so that they don't capture a dramatic picture of your eyelashes waving grossly into the frame because of a spastic blink that you can't help doing.
And before any of that unpleasantness, a blood pressure test! Which I didn't do very well on (143/83), but this was just before the awful glaucoma test, so naturally I was tensing up already. Of course, I'm not really objecting to the idea that I have an annual glaucoma test. Glaucoma is a serious and not-all-that-rare problem, and like most serious medical problems it is more common among diabetes patients than among the general population, so if you have diabetes, you do need your annual glaucoma check.
Later, when I got to see my eye doctor, he brought up the creepy results of the retinal scan, which look like this (this is a photo of one of my own actual scans, though not this year's):
These pictures always look to me like images sent back from some NASA space probe sent to examine one of Saturn's more low-rent satellites. Even the healthiest possible retinal scan never looks like healthy tissue to my amateur eye, but doctors see these things a little differently.
I am extremely nearsighted, which means that my eyeballs are stretched out horizontally -- this elongation can cause the tissue of the eyeball to be torn, and the retinal scan will reveal evidence of that (but didn't, thankfully, today). More significantly, I have diabetes, and my retinal scans need to be carefully examined for signs of blood vessels leaking, or damaged optic nerves. Such problems are pretty common in diabetes patients, but fortunately there was no sign of them in my scans today.
Actually, my eyes seem to be pretty stable right now; there was no change in the prescription for my contact lenses, or for the reading glasses which (as an officially Old Person) I must increasingly rely on for viewing anything up close and personal.
After all this good news was out of the way, I asked my eye doctor about recent reports that drinking coffee has a preventive effect against the sort of eye problems associated with diabetes. He was inclined to take a lightly humorous view of the matter, noting that his wife (who drinks much more coffee than he does) is always pleased to refer him to research which seems to show that coffee has health benefits, but is less interested in later research which seems to contradict the original, optimistic findings.
Health studies are difficult and expensive to do, and they often involve either animals (the recent coffee study was done on mice) or very small numbers of human subjects, so that any conclusions generated by them have to be very tentative, and might be overturned by other studies later. And I think we should always be especially skeptical of any study claiming health benefits for a commercial commodity (are we sure the coffee industry played no role in supporting the research which seemingly shows that coffee can prevent eye disease?).
On the other hand, I like drinking coffee. So, like my eye doctor's wife, I'm going to continue indulging this habit, and continue telling myself that it's one of the reasons my retinal scans keep coming out fine, year after year.
First Thursday Update
Thursday, May 1, 2014
Fasting Glucose: 94 mg/dl.
Glucose 1 hour after lunch: 119 mg/dl.
Weight: 195 pounds.
Blood pressure, resting pulse: 103/71 mmHg, 65 bpm.
Exercise: 4.6 mile run.
Now the weather's heating up, with temperatures in the high 80's during today's run and yesterday's too. With the low humidity of the California coast, that kind of warm weather is not as hard to run in as it would be in, say, Texas (I went running once in Austin, in similar temperatures but much higher humidity, and ended up being surprised I lived through the experience). The only real problem I have with doing my lunchtime run in warm weather is that, even after the coolest shower I can stand, I continue sweating for a half-hour after it's over, and I return to my desk looking as if I skipped the shower and just put my work clothes back on. Fortunately, I usually don't have any meetings to go to at that time of day, so there isn't a lot of opportunity for me to walk into a conference room looking as if I just ran a marathon and haven't had time to clean up.
Finding things that can make a difference
Managing Type 2 diabetes requires us to think, every time we eat a meal, "What kind of impact is this going to have on my blood glucose, and how can I minimize that impact?". Getting regular exercise is one of the more effective things you can do about this, because muscles that are regularly used are more insulin-sensitive, and do a much better job at serving you as your sugar-sponges (soaking up glucose whenever it spills into the bloodstream). But that's a very general thing, affecting every meal of the day. We also need to think about ways limit the impact that any individual meal has on blood glucose.
The main thing we can do to limit the impact of a particular meal is to limit the carbohydrate content of that meal. (Forget "sugar" -- carbohydrates in general are just sugar waiting to happen, so don't kid yourself that starch is any better -- by the time you swallow it it's already turning into sugar, because saliva is all it takes to break it down.) Sometimes you can tweak a restaurant meal in the right direction by choosing a green vegetable over a starchy one, or at least substituting a less starchy, more fiber-rich alternative, such as beans instead of rice in a Mexican restaurant. (Chinese restaurants are harder to deal with -- most of them want to bury you under a mound of rice or noodles.)
Breakfast foods (at least in America) are traditionally very high in carbohydrates, which makes the morning meal especially challenging for diabetes patients. I would suggest steering away from bowls of cereal and towards foods that emphasize protein and perhaps fat over carbohydrate. Eggs are a better choice than cornflakes (which come close to being pure carbohydrate), and recent research supports the idea that protein-rich breakfasts tend to improve glucose control. And even for breakfast foods which are a bit carbohydrate-centric, consider the lower-carb versions of them. I found that this Icelandic-style nonfat yogurt has 17 grams of protein and only 14 grams of carbohydrate...
...as compared to 5 grams of protein and 33 grams of carbohydrate for Yoplait Original Strawberry. You may not be able to find anything quite like Smari Organic Icelandic Yogurt at your local grocery store, but if you compare the nutritional labels on the yogurts that are on offer there, you will probably find strikingly large differences between one choice and another.
There are reasons to think that milk proteins (whey, in other words) are unusually useful proteins in diabetes management. A recent study found that whey proteins (as compared to proteins from fish, eggs, and grains) limit the glycemic impact of a meal in two ways: by delaying emptying of the stomach, and by stimulating a larger release of insulin (apparently by releasing into the bloodstream amino acids which support insulin production).
Because whey proteins have this helpful effect on blood glucose following a meal, you might even find it helpful to add whey protein powder to meals as a supplement -- it is pretty close to pure protein, and could have the effect of blunting the impact of whatever carbs are included in a meal.
However! I hasten to add that, if you want to experiment with whey protein powder in this way, you need to gather data on yourself to see if it's actually working for you. Don't sprinkle whey protein powder on your clam chowder just because you read on my blog that it might offset the effect of the potatoes. No matter how well something works for other people, in terms of diabetes management, it is always critical to establish experimentally that it really works for you. (Also, you might want to find out if whey powder tastes good on clam chowder -- for all I know it may be awful.)
What I think is actually important here is to keep hunting down ways to make your meals have a less severe impact on your blood sugar -- without making your meals such grim affairs that you want to chuck diabetes management out the window, and live on pizza and milkshakes until you die from it. We want to avoid extremism in either direction, do we not?
There are a lot of ways to tweak a meal to make it less burdensome to your bloodstream; keep an eye out for possibilities at all times. But be sure you test those possibilities, to make sure they work as advertised.
Diabetes is a highly variable and individualized disease; what works for someone else is always worth investigating, but should never be taken on faith. Grounds for faith are too shaky here.
"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!)