Diabetes Basics Part 5

blood tests

We left off talking about the importance of monitoring in diabetes, but we need to avoid the rather silly mistake of just paying attention to what our blood sugar is in the short term.  Things that put our blood sugar down in the short term can hurt us, and often we need to see it rise in the short term to improve the disease, much like getting off a drug produces withdrawal symptoms as the body re-adjusts and heals.

Dr. Hite, whose FAQ article called Diabetes Basics is the topic of this series, makes particular note of the fact that there is no cure for diabetes, and a lot of diabetics wonder about a cure, and some people will even define cure as well controlled blood sugar, even though it really isn’t.

Some will claim that we’re not cured unless we can go back to the terrible diet that we were on before, or the one that a lot of people eat, and have well controlled blood sugar on that, or even be able to pass an oral glucose tolerance test in the normal range, which would be under 140 after two hours.

This is nonsense though as people don’t need to eat very high carb diets and really shouldn’t, we don’t want to say that we’re only a non alcoholic if we can drink way too much and not get liver damage, drinking this much is just plain bad for you, as are very high carb diets.  People don’t drink 75 grams of pure glucose  at once, so who cares what your blood sugar goes to if you did consume this.

This still can be a measure of one’s hardiness toward ingested glucose, the 75 grams and the over 300 grams a day of carbs or whatever, but for practical purposes a cure means that you are no longer suffering from the condition, and we can’t exclude taking positive steps to help ourselves like eating a more blood sugar friendly diet when this helps us.

Some think that you have to have non diabetic blood sugar and not be on any medication to be cured, although it’s accepted that medication can cure people of things, so this one doesn’t make sense.  I will say though that this can lead to confusion because it’s not difficult at all with a lot of people to restore their blood sugar to normal for a time, for instance by injecting enough insulin, but this is far from a cure because there’s just so much more to this disease than high blood sugar.

If we were to look at how medication may cure us, we’re going to have to look deeper than blood sugar, for instance we could instead look at insulin resistance, but even that isn’t going to tell enough of the story, we’d have to look at various markers including one’s blood sugar, insulin levels, glucagon levels, and see that they are all close enough to normal to say that we don’t suffer from this metabolic disease anymore.

That’s a lot harder to do than you may think, but in any case what we’re after here isn’t a cure per se, but managing our disease properly, managing all of the potential risks and consequences of it, and this does involve more than just measuring blood sugar to be sure.

Measuring blood sugar is pretty much all conventional medical practitioners care about, and this includes our diabetes educator friend here.  Getting back to the article, he mentions what he calls his 5 M’s of diabetes management, and the first one is monitoring.

So he’s talking about monitoring our blood sugar levels here, and this can indeed be informative, and in the right hands this can help us manage our diabetes better, but it can also hurt us, and hurt is in a very serious way, taking us in the opposite direction from where we need to be going, toward worsening our disease.

In Part 4 I spoke about the patient with blood sugar over 300 on over 100 units of insulin, and 100 units of insulin is a huge amount, although it’s not that uncommon for type 2’s to be on this much or even twice this much or more in some cases.  We’re talking about a massive amount of insulin resistance, and actually a massive amount of extra glucose being infused into our blood from our liver.

This is how we get high blood sugar from insulin resistance actually, it’s not from glucose being trapped in our blood because our cells can’t take it in, if that were the case we wouldn’t be able to get out of bed and we may even be in a coma or die depending on how little glucose uptake we’re talking about.

Anyway, how this patient got into this predicament is that his body’s glucose regulatory system got out of whack after many years of exposure to toxic levels of insulin, this is how insulin resistance starts, and you always need too much of a hormone to become resistant to it.

So over time this messed up his body’s glucose regulation and more and more extra glucose was put into his blood.  This extra glucose is apart from the normal amount that we get from dietary sources and is actually from non dietary sources, like from certain amino acids, glycerol from triglycerides, and pyruvate and lactate, byproducts of metabolism.

So the flow chart here goes from high insulin to insulin resistance to too much glucose from non glucose sources, and blood sugar goes up.  So we can test someone’s insulin levels in this state and see that they are too high, although we don’t bother, and when you have high blood sugar and insulin resistance, which is all pretty obvious, if we increase the insulin levels to even further beyond what is normal and healthy, this will lower blood sugar in the short term but raise it over time because you’ve now worsened the insulin resistance, causing more and more extra glucose to be secreted.

So as time goes by, insulin resistance gets worse, you need more and more insulin, which makes insulin resistance worse and worse, and finally you can end up in the state that this patient did, with very high blood sugar on a very high dosage of insulin, as well as dying from cardiovascular disease, and that’s the biggest risk of high insulin over time.

So if we’re just going to measure blood sugar, and not think beyond this, this is exactly what can happen, to various degrees, and we may not end up as bad as this fellow did but this short sighted approach of just paying attention to blood sugar does take us completely in the wrong direction if that’s all we’re paying attention to.  Sadly though that’s all we typically ever pay attention to.

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