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.

disinformation and blame

Jan Chait issued a gem of a rant about the news media's collective villainizing of Paula Deen, and the wave of prejudice and mis/disinformation it rode:

There are 300 recipes for macaroni and cheese on the Food Network’s Web site[....] Mac and cheese with two cheeses. Three cheeses. Four cheeses. SEVEN cheeses! Mac and cheese with ham…with bacon…with corned beef. With heavy cream (four cups in at least one recipe). With Tater Tots.

The recipes were from such celebrity chefs as Ina Garten (the Barefoot Contessa), Alton Brown, Giada De Laurentiis, Guy Fieri, and Emeril Lagasse (who once had an episode called “Pork Fat Rules.” BAM!). And, oh yeah, Paula Deen. Who, admittedly, deep-fries mac-n-cheese.

But people are only complaining about Paula Deen cooking starch- and fat-laden foods. Why?

[continued: DiabetesSelfManagement.com]

Chait also provides plentiful links to counter the media's heaping helpings of pasture pie.

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 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.