The blog is dead, long live the feed!

For curated links on research for management, control, and possible remission of type 2 diabetes mellitus, please see:

• current @T2DRemission on Twitter
• archive Michael.Massing on Pinboard

Pending further developments,these posts will remain online; each represents my best understanding as of the time of publication. Posts are subject to review as science, clinical practice, and my thinking (e.g., about reliance on dietary animal protein) evolve.

Here and elsewhere, read critically. Your life and wellbeing depend on it.

back on track

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 data

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.

slip-sliding away

I like to keep my eye on the feeds here. Each has its own value.

Diabetes Self-Management works as a go-to site for the newly-diagnosed and long-term managers alike. I follow it primarily for the regular bloggers, and especially for David Spero's examination of questions not satisfactorily answered by current medical and diabetic orthodoxy. His savaging of the distorted reporting of one phase of the landmark ACCORD drug-treatment trial—including outrageously harmful comments by medical experts—stands as a cautionary tale against believing what you read in even respected sources in the popular press.

What caught my eye today was Eric Lagergren's Intake Accountability. I knew from the title I had to read it.

I've briefly mentioned "backsliding" out of remission, my current attempts to restore self-preservative sanity to my diet, and the need for diabetics to "meter" their food intake as rigorously as they monitor their blood glucose levels. Lagergren nails the process by which this discipline can fall apart. I wish him and all of you success in restoring or maintaining the necessary accountability.

And I remind myself that my own success will depend on more than wishing.

(Thanks to jlesage via Delicious.com for directing me to this invaluable site!)

remission defined

As reported in Endocrine Today online:

The [expert study group*] agreed upon the following definitions for patients with type 1 and type 2 diabetes:

• Partial remission: hyperglycemia below diagnostic thresholds for diabetes; at least one year’s duration; no active pharmacologic therapy or ongoing procedures.
• Complete remission: normal glycemic measures; at least one year’s duration; no active pharmacologic therapy or ongoing procedures.
• Prolonged remission: complete remission of at least five years duration.

The term remission may be more accurate than the term cure because “current or potential future therapies for type 1 or type 2 diabetes will likely always leave patients at risk for relapse, given underlying pathophysiologic abnormalities and/or genetic predisposition,” the group wrote. “It may make sense to consider prolonged remission of diabetes essentially equivalent to cure.”
The group modeled its consensus definitions on existing terminology for certain malignancies such as cancer.

*The group comprised experts from pediatric and adult endocrinology, diabetes education, transplantation, metabolism, bariatric/metabolic surgery, and (for another perspective) hematology-oncology.
source: Buse JB et al. Diabetes Care. 2009;32:2133-2135.

remission? cure? control?

2003/12/16 "Looks to me like you're not diabetic anymore."
—my Kaiser Permanente doctor

Wow. I didn't think they were allowed to say that. Nor that any doctor would ever say, as mine did later in the same conversation, "You've cured yourself."

As I've learned since, only the first of these statements is true. Being "not diabetic anymore" can serve, with certain caveats, as an attainable goal in diabetes control. This is what I, along with more and more lay people and professionals, call remission.