Type 4 Diabetes

A Personal Best

Winter was late arriving in the Washington, DC area, but it's finally here. By late yesterday (Tuesday), winds were blowing, skies were gray and the temperature continued to fall. Not the best conditions to lull one away from a fire-warmed living room and into the cold for a drive in the dark to a chilly locker room and then into the pool for a long swim. But, I have made a commitment to myself. And, the evening held a surprise for me  — a personal best in terms of amount of time and distance swum in one session. (personal best, that is, of the last two decades).

90 minutes and just over 2 km (1.25 miles) — with a few breaks during the 1.5 hour practice to talk with others on the team in my lane and to sync our routines.

The distance and time were remarkable for me. But, even more so was the ease with which I achieved those numbers. Three days earlier I could barely make 1/2 the time and distance and was short of breath while  experiencing muscle fatigue and light headedness.

Granted that swimming twice of week will naturally lead to improvements and greater endurance. But, in just three days? It was a proverbial "day" and "night" difference.

Significant in difference were the glucose readings. On Saturday, I began to swim with a blood sugar reading of 95. Tuesday, I was at 138 — just below my own targeted ceiling of 140 and at the edge of going from normal to hyperglycemic (high blood sugar). 90 minutes later, 85 (well below my own lower target of 100).

Obviously, in 90 minutes my glucose dropped considerably (for me). Yet, no discomfort, no pain, no complications I experience every time a drop of that magnitude occurs. What made the insulin-adrenaline interaction work in this case? And what does this say about the target glucose level I need to achieve before exercise?

As always more questions than answers. But, at least, a direction to follow.

James Hirsch on 'Cheating Destiny'

In his new book, Cheating Destiny: Living with Diabetes, America's Biggest Epidemic, James Hirsch pens a heartwarming and insightful, gut-wrenching and alarming first-hand account that should be on your short-list of "must read" books.

He writes not only of his 30 years of living well with Type 1, but the experiences of coping with the sudden diagnosis of diabetes in his 3-year-old son, Garrett. The obvious love and support that James has for Garrett radiates throughout the book. But, so does his sense of despair of not being able to protect his son from the pain and complications that accompanies diabetes even in the best managed of cases.

He writes, in addition, of his concern for the state of American health care in the 21st Century as we face an exploding diabetes epidemic. Our system responds well, he notes, to critical care emergencies, but sadly fails in dealing with chronic disorders. He offers valuable insights into the history of diabetes and how we arrived at this crisis point. His perspectives on the "politics of diabetes" is enough to make one scream. I did. Several times.

He paints a horizon filled with ominous storm clouds. But, through that darkness, some wonderful streaks of light appear in the heroic stories of real people, both medical professionals and patients, who merit our admiration and applause. The power shown by these people offer all the evidence required to be convinced that one person can make a difference The journey is not easy, but the outcomes are worthy of the effort.

Please read his book. You can find it on Amazon.

Now Available on Amazon and in the UK!

Type 4 Diabetes is now available on Amazon and Borders sites. For those in the UK — and elsewhere in the EU — the book is also available from The Book Depository.

My thanks to all of you for buying the book on Lulu.com. If you want the fastest delivery, Lulu is the best choice at the moment.

Dealing with Fibromyalgia

The decision to include fibromyalgia in my book came late in the year. As with most people, I had very little understanding of fibromyalgia and, to be honest, had the preconceived notion i that the disease was the exclusive province of women. How wrong I was.

While it is fact that far more women than men report and are diagnosed with fibromyalgia, it doesn't men are immune. And, there are some real questions being raised that could lead to many more men being diagnosed with fibromyalgia.

My introduction to fibromyalgia came as I researched extensively for some clues about the aberrant insulin-adrenaline reaction that appears to be a critical part of the Type 4 Diabetes story. I first heard about this reaction from one of my doctors in a discussion he had with a researcher at the National Institutes of Health. My doctor knew nothing more, and I became naturally obsessed with learning more.

After months of research, I came across the writings of Dr. Paul St. Amand at UCLA. For decades, Dr. St. Amand has been treating himself and thousands of patients for fibromyalgia. Interesting side note: for all of his experience and expertise, Dr. St. Amand notes that even he was reluctant at first to talk much about his work into fibromyalgia with his colleagues in the large medical practice he operated.

Dr. St. Amand observed that many of his fibromyalgia patients suffered from symptoms of hypoglycemia (low blood sugar.). In the years that followed his first observations about the relationship between the two disorders, he longed for an explanation. Lacking evidence from other professionals, he arrived at the conclusion that the underlying cause was due to a sensitivity to carbs that leads to elevated insulin levels and rapidly decreasing glucose levels. This, in turn. triggers the release of excess adrenaline to halt the decline. Excessive adrenaline then sparks a serious of reactions including irregular heart beat, headaches and gastrointestinal problems. All of are symptoms of hypoglycemia, fibromyalgia — and autonomic neuropathy.

Think about it. If we understood this spent the time and money to research and understand this link, how many people would benefit?

What is fibromyalgia?

Just latching onto a concise, useful definition for fibromyalgia is often the first major challenge for people dealing with the disease. Despite the fact that the American Medical Association recognized fibromyalgia as a  true illness in 1987, too many doctors somehow "missed the memo."

In searching for medical definitions, I really put faith in Wikipedia as a simple, easy-to-locate source for anyone with even limited Internet access:

Fibromyalgia (FM or FMS) is a chronic syndrome (constellation of signs and symptoms) characterized by diffuse or specific muscle, joint, or bone pain, fatigue, and a wide range of other symptoms. It is not contagious, and recent studies suggest that people with fibromyalgia may be genetically predisposed. It affects more females than males, with a ratio of 9:1 by ACR (American College of Rheumatology) criteria. Fibromyalgia is seen in 3% to 6% of the general population, and is most commonly diagnosed in individuals between the ages of 20 and 50. The nature of fibromyalgia is not well understood, with many frustrated physicians driven to accusing their patients of feigning illness. There are few, if any, treatments available. Although there is no cure, the disease itself is neither life-threatening nor progressive, though the degree of symptoms may vary greatly from day to day with periods of flares (severe worsening of symptoms) or remission.

The Link to Fibromyalgia

I can truly empathize with the many people who battle not only  fibromyalgia, but also those that still believe "It's just not real. It's all in her head." I have heard many similar comments about my discovery of a link between neuropathic pain, hypoglycemic complications and raising glucose levels. All too many times I have heard professionals tell me that "it's in my head." Which? The neuropathy or the elimination of all the pain and complications?

I have watched several close friends and relatives battle fibromyalgia over the years and struggle to get the information and support necessary to cope effectively. Hopefully, this book and blog will promote research that can improve all of their lives.

This week, I will be posting items that focus on fibromyalgia and the potential link to faulty glucose metabolism. For those that are looking for more information specifically about fibromyalgia, I invite you to visit The Fibromyalgia Research Blog

Measure Yourself

Extending and reporting on my journey into the pool has nothing to do with boasting about swimming so many laps in an hour. Of course, I am proud of my accomplishments. But, please remember I trained from an early age to swim and it comes very naturally to me. On the other hand, I can't run to catch a bus — just ask anyone in my family. They laugh at my feeble attempts. Really!

The reason for writing about my exercise is to encourage you and everyone else I can reach to:

• Set reasonable exercise goals for yourself — and a pattern to achieve them even if it is just walking 20 minutes a day
• Measure your blood sugar levels before and after — and even during if you start to feel lightheaded
• Come back here and share your results with others

Only by teaming up as patients can we impact the medical and research community to focus more attention and resources on the broad range of glucose metabolism problems.

Into the Swim

Two practices on the board and in the Daily Tracking Log. The first swim practice lasted an hour and I actually managed to rack up 50 laps. Lots of stops and starts and a break when I knew that my blood sugar was reaching too low a level for me. No, it wasn't pretty. I was in the slowest of six lanes with five other nice men and women pushing as hard as they could to accomplish the goal for the day. It was hard, but I felt an enormous sense of accomplishment when it completed. The last time I swum that much occurred more than 12 years ago. Never thought I would get back to this level. This was my goal: to push past previous limits.

The Saturday practice was over a 9 am. By mid-afternoon, I knew that I had pushed hard. Started to feel the pain (headache) and mental sluggishness that comes with rapidly decreasing/lower blood sugar levels. Pushed back with 8 grams. Tested 30 minutes later and took 8 grams more. A nap followed and then an early dinner.

Woke up in the middle of the night with terrible pain, mostly headache but overall pain as well. Glucose level was 84 (very low for me). Took 12 grams and several Advil. Slept the rest of the night and felt fine in the morning. Put away the holiday decorations all day Saturday and by Sunday afternoon I was crashing hard.

It is thankfully amazing how quickly you can forget the misery of a high level of neuropathy pain — when everything hurts from the top of your head to your toes. Add to that the problems with digestion and blurry vision that accompanies this episodes, at least for me. Oh, what a very unpleasant reminder Sunday afternoon and evening turned out to be.

I watched and worked with my glucose levels all afternoon and evening and went to sleep early. I woke Monday with minimal discomfort and by that afternoon, I seemed fine. I continued to improve rapidly enough so that by Tuesday I felt good enough to tackle swim practice #2 in the evening.

The Tuesday practice came off well (still not an exhibition in good swimming form, but whatever!). About the same distance in the same 60-minute period. Before leaving the locker rooms, I checked the glucose level. Now at 86. 8 grams later and it was heading back up. Arriving at home, I made sure that consumed an ExtendBar (I had forgotten to do so on Saturday evening) before bed.

Wednesday morning was fine though understandably a bit muscle sore. Watched what I ate balancing carbs, proteins and fats and feel fine today, Thursday. Only brief glimpses of pain and the related neuropathy/hypoglycemia symptoms.

Indeed, it's going to be interesting over the next few weeks to watch how my glucose levels trend in response to all of this exercise. For the time being, I am going to stick with a 60-minute swim twice a week. And, do so with a big smile on my face.

How Low Can I Go?

The fundamental mystery that drives Type 4 Diabetes is why I (and by extension many other people)  experience symptoms of severe diabetic hypoglycemia with glucose (blood sugar) levels between 90-100 — far above the "generally accepted" threshold of 40 or so. And, how could I experience these symptoms in the absence of insulin injections and/or oral diabetes medications?

The very early evidence points to an abnormal interaction between insulin and adrenaline, two critical hormones that have much to do with how our bodies store and use glucose. Among the many questions raised by an aberrant insulin-adrenaline reaction is the topic of insulin resistance that forms the basis of the accepted understanding of Type 2 Diabetes.

As opposed to Type 1 (an autoimmune destruction of insulin-producing cells), Type 2 is believed to develop when the normal absorption of glucose by cells is inhibited. The primary role of insulin is to "unlock doors" into individual cells so that glucose can enter and be used as fuel. In the absence of sufficient insulin levels or if a molecular shift takes place causing a change in the insulin "keys" and/or the "glucose door locks," then your cells do not get the proper amount of glucose fuel to function.

The Diabetes Prevention Program, the NIH's landmark study in the 1990s, concluded that exercise reduces insulin resistance. How? That is unknown, but exercise does improve the function of insulin and the flow of glucose into cells. The accepted wisdom, though, is that exercise somehow makes the "keys" fit more precisely into the "locks".

But, for the moment, what if exercise does not fundamentally change the "locks & keys"? Instead, what if exercise improves a faulty insulin-adrenaline interaction? A different reason for the same result.

A goal of my regimented exercise program over the next six months is to study how I react to a constant pushing of myself physically — to my limits and then to establish new limits. Will this exercise change the level of glucose at which time I experience symptoms of diabetic hypoglycemia and/or autonomic neuropathy?

Will my numbers change. And, if so, how low can I go?

Exercise Your Way

One of the best aspects of exercising as an adult is that, unlike gym class, you can do it anyway you want. No one is telling you how and when to do it. Running, biking, tennis, weight lifting, yoga, take your pick. You can even walk your way to health and fitness. As Nike tells us "Just do it." If you really hate to exercise, consider buying "I Hate to Exercise Book for People with Diabetes" from the American Diabetes Association.

For me, it's swimming. Always has been and I suspect always will be my choice of aerobic activity. Until a few years ago, I had no idea why I am so attracted to fitness in the water. As noted in the book, medical evidence now exists that blue-eyed blonds are genetically predisposed to swimming.

And, so in order to keep my 2007 resolution on fitness, I decided to join the local masters swim team and set a goal of competing in my first meet in May. Setting that as a target helps me to comply with exercise guidelines set forth in the NIH's Diabetes Prevention Program. It also pushes me to go over my limits and experience again neuropathic pain and complications.

NO, I am not doing that because I enjoy pain. I am a wimp. Rather, I want to further my understanding of the Type 4 Diabetes link, study the fluctuations in glucose levels and develop more comprehensive profiles that I can share.

If you are into sports and exercise, take a look at the website for the Diabetes Exercise and Sports Association.