information gaps

Are there "gaps" in what you hear and read about diabetes? An online survey for people affected by the disease(s) is gathering "missing" information to incorporate into educational videos.*

Distortions and omissions in the diabetes discourse are a recurring theme here - usually how:

• Medical research is dominated and distorted by deep-pocketed industrial interests.
• Standards for self care and even for diagnosis are shockingly - it is no exaggeration to say fatally - inadequate.

My top-of-mind short list for the biggest diabetes information gaps includes: 

• Diabetes is complicated. Volumes of research produce inconclusive and contradictory results.
• Diabetes-related research may be badly reported, or just plain bad.
• Evaluating research, assessing risks and benefits, and devising a working strategy for self care are not helped by the cognitive deficits, depression, and fatigue associated with blood sugar highs and lows.
• Drugs used to treat diabetes and/or its comorbidities may increase the risk of death or morbidity, including onset of diabetes itself and incidence of comorbidities. 
• Blacks, Hispanics, American Indians, and Pacific Islanders are known to be at higher risk for developing diabetes. Less discussed are the risks conferred by a range of circumstances: socioeconomic status, stress, sleep, inadequate health literacy and education, location, and exposure to environmental pollution. These factors often trump genetics; they can increase diabetes incidence and/or worsen outcomes.
• Lack of professional consensus, balky insurance plans, and physicians' disregard of patient-reported data may all interfere with getting adequate testing supplies to carry out tight glucose control.

In short, diabetes usually cannot be resolved by, as one pharmaceutical company shamelessly touts, "simple changes."

Of course, those of us with type 2 diabetes have it "easy." Those with type 1 can match all of the above point for point (with some variation) besides being burdened with:

• fewer treatment options 
• a more painstaking, invasive, and wearying—and typically decades longer—self-care routine
• immediate and potentially mortal risks that can come from monitoring and treatment errors

Cheery thoughts for a sunny winter's day! Well, they asked.

Good heath and good luck,

M.

*The survey is sponsored by wegohealth, a platform for online "health activists"; they will donate to diabetes organizations based on survey participation. I don't know much about the sponsors, but they are asking the right questions.

so who's normal anyway?

Here's a secret. When it comes to blood glucose levels, nobody knows what "normal" means.

As noted before, medical research finds increased incidence and risk of diabetic comorbidities or "complications" (late-stage symptoms) correlating with blood sugar levels currently deemed "pre-diabetic" or even normal.

We know this more precisely now, yet it's nothing new. The correlation of elevated blood glucose with morbidity and mortality is long-established; it informs our current definition of normal as fasting blood glucose under 100 mg/dL, although in an entirely inadequate way.

As long ago as 1980, impaired glucose tolerance (defined as blood sugar levels of 96 mg/dL or greater after a clinically-administered "challenge" of 50 g oral glucose), roughly doubled risk of death due to coronary heart disease.

In short, that level of post-challenge glucose intolerance, several points within today's "normal" fasting range, kills people. Quibbling over the additional 25 mg/dL that distinguish the "pre-diabetic" from the diabetic seems as useful as speculating over how many angels can dance on the head of a pin.

more on the risks of current norms

p.s. I was recently surprised to find an untapped prescription for glucose test strips, and was able to get it extended. I'm gathering new data on my own progress and setbacks, and should be able to publish them soon. I shall also finally incorporate into the data the standards for normoglycemia that have been tightened - obviously to my mind not enough - since my original intervention in 2003.

back with the program

I'm returning to the plan from 2003. I've been losing about three pounds a month since March.

I also finally got some pharmacy issues sorted out, and have glucose meter test strips again. Early results are good:

• Most results are in the normal range, less than 100 mg/dL glucose.
• I am still subject to some version of the "dawn phenomenon", with morning fasting readings around 120.
• On the other hand, I may have responded "non-diabetically" to a big dish of ice cream right as I started testing, with a 2-hour postprandial reading of 128. (But see below. And no, big dishes of ice cream are not part of the plan.)

Separating meals by a minimum of four hours is critically important for these results.

In the next series of tests, I need to get a better idea of where my postrprandial peak falls. I know it's longer than two hours, probably closer to three. With that done, I'll post more detailed results.

I have some new ideas about the elevated waking readings - sleep apnea has been ruled out - and hope to be able to score some more strips to test those soon.

p.s. I've updated the dataset download page with PDFs of some input and outcome overviews.

remission dataset

Changes in access to Sky Drive apparently broke the remission dataset link here: the old landing page, with a summary note and a download link, seems no longer available. My bad for not verifying Microsoft's assurances of continuity.
For now, Box.net wins as host, despite requiring a click through a poorly labeled comments icon to show the summary information:

This Excel database documents - and also provided a tracking and management tool for - the process by which I lost 100 pounds of fat and rendered myself, according to my doctor, "no longer diabetic" within a year of a diagnosis of type 2 diabetes. Please note that I do not claim, despite my doctor's use of the word, to have "cured" myself of diabetes. I believe I have documented putting myself into remission - normoglycemia - an asymptomatic state. Day-to-day data are self-reported. All medical outcomes are documented by Kaiser-Permanente.

Microsoft, Apple, and Google are not as on top of web-based file sharing as they proclaim. None of them yet deliver a web view of 15 densely formatted and linked Excel sheets and charts. I had to dig a little even at Box to find a page that didn't falsely promise that it could. I should stop ranting and think about putting up some PDFs.

I apologize to anyone who was frustrated in trying to download the dataset.