Friday, February 3, 2012

Initial Post

Camarillo, California. February 2, 2012. Initial Blog
I wrote this blog to highlight my new book – At the Precipice and its website  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. 
Jim Snell


At January 16, 2013 at 12:39 PM , Anonymous Anonymous said...

Wow! Very interesting. Thanks for this!

Congratulations coming to understand on your "leaky liver" and getting it figured out. Your own path to discovery / understanding glucose metabolism and insulin resistance has paralleled mine.


At February 28, 2013 at 2:38 PM , Blogger jim snell said...

Thank you for writing.

The big unfortunate issue in all of this is the simplistic approach being taken to a multi-organ, multi hormon complex chemical plant that can be anayzed down to just the pancreas and insulin levels.

The liver plays a huge roll in all of this with its huge buffer for glucose - a days worth. It is said that the muscles store 10 times as much.

It is liver that keeps body running steadily along with insulin help from the pancreas between meals and no eating.

This fifo buffer gets overlooked in my opinion and its influence on T2 which I believe is very signifigant.

Not everyone is suffering from over active livers that persist in adding too much glucose during fasting ( as mine did.)

Apparently you were as well. It is turining out the roll of metformin in Liver has now been proven out in mice experiments this year Jan 6, 2013 where metformin in the blood acts to signal directly to a liver with faulty signalling to hold back the glucose release by interfering/antagonizing the Glucocon from the pancreas. See article in Science News/Nature on latest findings on metformin ( not guesses and theories)

Thank you and best wishes.


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