advances in type 2 diabetes care and thinking
Thursday, February 9, 2012
Camarillo, California. February 9, 2012. Post # 2: Caveats, apologies and exceptions
In this second blog, I want to set the stage; detail the caveats, apologies ,exceptions and share the difficulty of resolving this disease.
Coming off my Book – At the Precipice and my Doctor’s comments that what he and I were doing as well as all the behavior and data logged that apparently did not follow his play book and guide to the Doctor, it became readily apparent much more research and comment was necessary, needed and important.
Not withstanding ones perspective, this disease is exploding out of control and some say it is exploding world wide with numbers of increase that suggest 200 to 300 percent. I do not care who you are, numbers like that even if my numbers are 50 percent too high are still ridiculously too high and throw into question the aspect of what medicine and the cures are really doing and their effectiveness and force us to ask why are we not making progress here.
First off, and thankfully in medical science and in most fields, there are incredible research gains, cures, drugs, and improvements in technical tools every day. That said, type 2 diabetes seems totally stalled in the dark ages with people and their bodies rotting out with apparent little progress on the horizon. That said, tons of money is being poured into “research” with what seems apparent little definitive progress.
Taking a break from medicine and hoping into a field I have had in-depth experience in; is advanced digital microprocessor electronics and networking. When I started in this field many moons ago, a multi meter and oscilloscope were mostly what was needed to design, debug , and correct these systems. As the complexity and speed shot up and complex integrated circuits took over, increasingly more sophisticated test and data capture tools that could capture multichannel signals and thousands of samples over time that enabled one to debug the behavior and actually get visibility of the problem. Guessing and swapping out Integrated circuits on a hunch readily became a crapshoot, wrong and inefficient.
Today’s tools for type 2 diabetes seem to resemble this same problem where presently there are no adequate tools with a total lack of quick visibility. Single shot lab tests, finger prick machines and if your lucky a continuous glucose monitor( – a step up from finger prick machine) are simply inadequate debugging a multi-hormone, multi-organ human digestion system consisting of stomach, liver, kidneys, pancreas, intestine, thyroid etc.; quickly and efficiently. Quite frankly, not to rip off appropriate metaphors and apologies to the Start Trek Movies and Dr. McCoy, we really need the 23rd century medical tools and the computers on the deck of the Starship Enterprise crunching the data down to help the Doctor get a patient back on track. I envision a loaner pack one wears for a few days to get a multi-day 24/7 picture of a patient’s body and what is really happening. We have the technology but no tools presently available!
Unlike a broken bone, bad hip, a virus or bacteriological infection that can be targeted quickly and easily and patched up; type 2 diabetes does not lend itself to the best of our battlefield medical skills and experience. This is a problem all rolled up with medical failures and problems, diet/carbs control – energy balance , exercise and aging – a multiphase problem that cannot be shot a single bug-issue at a time and in fact must be attacked on multiple fronts with extensive data availability of the hormones and organs involved. Single shot lab tests while a good place to start simply do not give us the 24/7 visibility to watch the interaction and parse out the failure issues.
Trying to solve this mess one problem at a time is like the old days of early multi-gun(three) CRT units which required one to adjust magnets on back of set to try an optimize the picture alignment. As one who has been there; one always got 3 corners of the tube in and left with one out. All one could do was get the best as one could and when adjusted the bad corner, the other three would be thrown out. Simply no joy.
Type Two Diabetes is like that, needing a multiphase approach of attacking medical problems, diet/carbs control and exercise as a complete whole to pull body back into the proper operating point. This also means a team of Doctors, Dietitians, Diabetes Trainers, Exercise consultants will be needed to arrest this problem promptly, effectively and keeping costs under control. A fifteen minute visit with Doctor and taking pills when you get home and call me in the morning will not simply cut it on this disease.
Right now due to any lack of consistent fast, accurate visibility and data, Doctors are reduced to educated guesses, experience , the wand of Merlin and much praying. This same problem of lack of fast accurate visibility facilitates a battling cluster of contending theories and ideas along with a host of supposed theories how the body works that more resembles a medieval science/medical text. Frankly this claptrap is neither helpful, useful nor gives a type 2 patient any idea how one can help save her/ his body by working with his Doctor/team. We are starting to see glimmers of light as powerful tools like magnetic resonance spectography tools are going where we never have gone before, and no dissection needed to get inside the cell to get data. In fact dissection cannot get one there.
Please do not throw rocks, stale buns etc. at your Doctor, as he like you is trying to do his best. In addition, due to quality and legal reasons he must follow the approved treatments his medical society has deemed correct and worthy and signed up for.
It is at this point where I need to tackle I believe is the one aspect of this mess namely lobbyists. They know who they are. These groups raise huge pots of money, lock in bad ideas and poor , bad, or misdirected philosophies which result in massive extra costs in care to the type 2 diabetics and in my opinion and mind stall out critically needed advances in medicine on type 2 diabetes. Simply put, a barrel of 50 test strips for a finger prick machine should not cost $ 77.00 at the local pharmacy off the shelf. These lobbyists have the dollars and clout to fix that immediately. Today, advanced research and new ideas are like the Holy Grail of an Indiana Jones Movie ; where these items sit locked in a box in a government warehouse out of sight helping no one.
When our American System works well including the lobbyists; we have a system and results that are second to none and we got to moon and Mars. If it gets off the rails, my opinion is we end up with the American atomic energy industry (with apologies); with costs blown out to the stratosphere with everybody with their hand out taking their “share”. In that case we end up with a situation where we spend more than any other country out there for a service and get far less for the money spent compared to those countries. Type 2 Diabetes does not look good from where I sit.
I believe we are At The Precipice like my book where we have incredible technology and a desperate need to make progress; and I believe we will see an explosion in new research and thinking. As we get further down the road; we will be like Dr. McCoy of Start Trek Fame of the Star Trek Movie – The Voyage Home; when Dr. McCoy runs into the aged lady sitting in the hall of a 20th Century Hospital in San Francisco and Dr. McCoy says “what the devil are you doing here? She says – Kidney Dialysis. Dr. McCoy shakes his head and says – What is this – the dark ages?. Dr. McCoy hands the lady a pill and says call me if any problems!. A few scenes later, we see the lady being wheeled out - all healed - ecstatic.
Once the darkness has been pulled back by light, we will also stand in horror looking back at what we were doing then in the 20th and 21st centuries on type 2 diabetes as well as amazed at what a lot of pioneers that were trying to resolve this mess without the exotic tools I believe are around the corner and yet at that time pioneering diets and addressing energy balance issues.
In the blogs ahead; I want to discuss the following issues:
1. The role of the Hunter Gatherer digestion Gene System and what genetics did include and what was left out.
2. Science and Agriculture and availability of 24/7 high performance refined foods and grains.
3. Key role of body energy balance that helps prevent rot and the role for the human.
4. Exercise is critical. Insulin does not burn off glucose; only exercise and process does.
5. Insulin efficiency versus glucose saturation. Human Blood system regulation relies on insulin from pancreas causing transfer of glucose from blood system to available space in temporary glucose stores of skeletal muscles and fat cells. As long as room in temporary glucose stores of fat and skeletal muscle cells; blood system will remain regulated.
6. Alternate theory on how the liver, pancreas, and skeletal muscles form a servo system to set the fasting glucose set point on the body and why type 2 diabetes progresses worse when one ages. ( From an electronics/survivor person) Why are we ignoring leaky livers?
Thank you for your time and interest and best wishes for good health.
Friday, February 3, 2012
Camarillo, California. February 2, 2012. Initial Blog
I wrote this blog to highlight my new book – At the Precipice and its website www.type2diabetesthinking.com as well as a follow on latest theories , thinking and new management techniques for type2 diabetes.
I am a survivor who nearly died with this mess almost wrecking my body, eyes, and kidneys.
It took 4 years from 2007 to arrest the mess and end up on the green side of the grass. I and my Doctor, nor I did not research or apply any esoteric new research and cures in any way and through carbs control/Diet, hearty exercise and targeted meds finally reeled the mess in.
I started on daily 26 units of 75/25 Humalog, 15 units of Lantus at night along with doses of starlix –oral pills, metformin and actos. By time I had CGMS (Continuous glucose monitor) running for a year, my meds list was stripped of the actos, starlix, Humalog 75/25 and actos and was replaced with more doses of metformin, 3 units of Humalog Lispro – standard fast acting for breakfast, 0 to two units at lunch and 0 to two units at dinner. The Lantus was reduced to 2 units at 9:00 pm. Metformin continued to be the key heavy lifter drug keeping world under control. I also lost 75 pounds on my diet from 330 pounds to 255 pounds and still dropping.
Until Liver was caged – kept under control with metformin; I could not lose an ounce for 2 years on a 1200 calorie daily diet and 2 miles walking. A1c was 13.3. Once liver caged in last 2 years, A1C dropped to 6.9 and I started to lose weight as well as see hemorrhages on eyes disappear/heal as well as kidneys stabilized.
By caging the liver, my Doctor and I were reducing the livers role in such key services as fifo buffer, dawn effect, emergency glucose add when blood glucose goes sub 70 and spurious liver dumps that occur when gut empties after meal. Basically my liver was always leaking too much glucose during fasting intervals as well as dumping whole liver spare glucose buffer on the Dawn Effect/Phenomenon(BG hiked to 238 by 6am), the sub 70 emergency glucose add function and the spurious liver dump would hike blood glucose to 511 and then BG would dilute and fall to 278/311 as heart pumped the glucose around body to dilute.
Metformin doses at right time near midnight turned off the gruesome dawn effect so my morning glucose reading looked just like midnight when I went to bed. Watching as Blood Glucose of Blood stream and adding small snacks/glucose when numbers headed to 100 to prevent the sub-70 emergency liver glucose being invoked. Taking my usual meal doses of metformin one hour before meal stopped fasting leakage as well as the spurious liver glucose adds from happening.
This is what I mean by caged. I feel like a ole locomotive steam engine fireman watching the sight glass to ensure the water(glucose) does not go too low and run out. Finding out strictly by accident by me failing to take a metformin dose at dinner and then near midnight, my blood glucose dropped to 180 from 238 pointing out very interesting effect. This led to taking a 500mg dose at 10:00pm and another at 12:00am midnight. Single large doses DO NOT WORK and the timing of doses on my body was key.
Originally, catching the liver dawn effect and the liver nonsense took some sleuth work. Initially as a experiment walking ( I remembered that hearty exercise always got my BG down in way distant past, I started walking ¼ mile loops and found reliably after 1.5 miles the meter would start to budge down and as I got to 2 miles, the blood glucose dropped fast to 140 and lower. Insulin would start working again and on my low diet, BG remained in good control until the liver kicked in on Dawn effect after midnight and boot the number back up.
I did this for over a year walking 2 miles in the morning each and every day. At one point I was curious who was messing up picnic, so I stayed up and did finger pricks all night long and noted repeat reliable numbers of 110 at 1:00am; 150 at 3:00am; and 238 at 6:00am. I had no snacks after dinner night before so only dog who could add this glucose was the liver. This stopped when I made mistake of falling asleep after dinner and not taking my metformin. The number was 180 instead – much lower. Ah Ha, metformin shuts down liver. Doctor worked to configure two doses at 10:00pm/12:00am midnight that proved successful.
The spurious liver Glucose add on gut emptying after a meal was traced and verified using the CGMS and arranging the up to strength period of the metformin dose. For me this turned out taking the meal dose one hour before ingesting meal. This stopped the last nasty liver dump function. Why the liver was dumping when the BG was in bounds from 140 to 190 is most bizarre and we never identified any work on net or anyone else who could shed some light.
In the end, I was glad to get my good health (most) back and feel way better. Today, it continues as I take my metformin and maintain my 1200 calorie diet religiously and one to 2 miles walking. I up the number of miles should BG show desire to want to go too high out of specification.
It must be strenuously emphasized that I never did and I have to assume my Doctor never did desperately research modern latest research looking for items to put on my medical care.
The more bizarre response was my Doctor who pointed out that the data and results matched nothing in his playbook. I was shocked. At this point; I went out on the web and found most curious research by the Salk Institute and John Hopkins dealing with what really is how Metformin works on liver and its horse power. John Hopkins had also figured out what genes and dose had to be to be effective. Mine was. I was shocked.
Incredible MRI spectrography studies done at the University of Newcastle on Tyne in England at their MagRes center on lean diets of 600 calories and watch pancreas recover. Their work suggests that Type 2 Diabetes is reversible and can be hauled back and is in fact an energy balance issue in body where a person is chronically over providing glucose from diet and in my case a leaky liver throwing back too much glucose as it is not working correctly during fasting. The Salk institute work suggests that Type 2 Diabetes folks have the switch in their liver to make/release glucose jammed on and only metformin up to strength in blood(affects liver) turn that off.
That seems to map the behavior I have had the opportunity to see and work with the last 3 years in detail.
The other curious effect I saw has to do with Insulin resistance. As I had this nasty leaky liver hammering me up every am (prior to metformin shutting off), I noticed that my body was deaf as a post to insulin. It just rotated around my blood system till I walked 2 miles and got BG back to 140 and under. Once I flushed out the glucose, the body was very sensitive to insulin. Prior to that I could add more (carefully) and see absolutely zero effect. In addition; today after fixing, the amount of standard Insulin is very small and no starlix oral pills and no actos.
The other unexplained effect was that after 6 months on corralled liver, I suddenly was having unexpected serious lows. Man, I was pealing out first the starlix – reduce doses first – no good. Remove entirely. Still big lows – I removed the 75/25 and replaced with very low doses of standard Humalog Lispro fast acting insulin. Back working fine. I could then see pancreas throw in meal bolus each time I ate. Amazing – Pancreas kicking but. I have been on these other and earlier pills for last 26 years or so. Thank God I had the Continuous Glucose Monitor to catch when my body’s pancreas went back to work to make all the other insulin-meds superfluous.
Another very important research MRI spectrography having to do with something NOBODY is discussing has to do with Glucose saturation of the skeletal muscle cells temporary glucose stores. Their work shows that if these stores get loaded, the cells to protect themselves turn off their response to the body’s Insulin to stop transfer of any more glucose. They called that Insulin Resistance.
From my perspective I watched that every day for a year as my liver saturated me each and every morning. The current mentality chatters about impaired or inadequate insulin and ignores that these skeletal muscle glucose stores have a finite limit and can be easily saturated.
If it won’t go in, pour on more insulin or jackhammer it in with actos.
Here again – more proof about energy balance and not exceeding.
Thank you for your time and interest and best wishes for good health.