It's been a month since I quit taking Actos. My fasting blood sugar rose about 20 points over about 2 weeks and then started back down. My weight loss accelerated for a while from about 2 lbs per week to 2.5 lbs per week (note: I weight myself every morning when I get up and average the whole week to get a "true" weight. Comparing weekly averages shows trends very well). This week I hit a minor milestone; I am now just fat, not obese. My BMI dropped below 30.
My weekly average fasting blood sugar this week is unchanged from last week. I started the week out moving down noticeably as the week moved on my fasting blood sugars have been steadily rising and there does not seem to be any apparent reason. They're now in the mid to high 130's. I've been sticking to my diet, consuming large quantities of fruits and veggies and small quantities of meat and fish and avoiding fats and sugars. I'm wondering if I have an infection somewhere that I can't feel...or can't feel yet. Hay fever maybe? I do have some congestion but not a lot.
For now I'll be patient and know that tomorrow starts a new week and hopefully a renewed downward trend in blood sugar and weight.
I've decided that its time to augment the diet with more exercise. The Nordic Track came upstairs, got dusted off and put to work for the first time in years. Six minutes was enough - could have gone longer but I was sweating and didn't want to over-due things. I will now be walking as before, riding my bike more, and using the Nordic Track. I just need to figure out a realistic goal. In my head I'd like to do an hour a day but I'm thinking 30 minutes, 6 times per week is more realistic. The correlation between exercise and lower blood sugar is clear but there I have not found a whole lot of qualitative information. What I have found seems unrealistic for me; 4 hours per day equals a 20% drop in blood sugar. That is a slightly bigger drop than what metformin typically does but I can't do 4 hours of exercise per day without giving up something I'm not willing to give up.
Saturday, June 18, 2011
Tuesday, June 14, 2011
The progress continues
About one month ago I reduced my Actos and about 3 weeks ago I stopped it entirely. Initially the blood sugars rose about 20 points and last week started back down again. While the blood sugar went up a little, the weight just started to fall off - the doctor suggested taking Actos might make it difficult to lose weight. Well, stopping Actos makes losing it easier. In the past month I've lost 12 pounds, which beats my 2 pounds per week goal by about 50%.
The really interesting thing is I've started getting some "normal" blood sugar readings. I even had an 89 mg/dl reading 2 hours after eating dinner one evening. The improvement in readings suggests to me that there may be physiological changes happening. I might be becoming less insulin resistant, which is the goal of my process. I just wish I could figure out how to push the outcome more in the direction I want it to go. Maybe not necessarily faster but certainly more assuredly in that direction.
In two weeks I see my doctor again and I should have blood work done. I am hoping to see improvements in the lipid screen, blood pressure, and HbA1c and have a reduction in those medicines. Time will tell.
The really interesting thing is I've started getting some "normal" blood sugar readings. I even had an 89 mg/dl reading 2 hours after eating dinner one evening. The improvement in readings suggests to me that there may be physiological changes happening. I might be becoming less insulin resistant, which is the goal of my process. I just wish I could figure out how to push the outcome more in the direction I want it to go. Maybe not necessarily faster but certainly more assuredly in that direction.
In two weeks I see my doctor again and I should have blood work done. I am hoping to see improvements in the lipid screen, blood pressure, and HbA1c and have a reduction in those medicines. Time will tell.
Saturday, June 11, 2011
Evaluating progress and planning ahead
After 11 weeks of eating to get proper nutrition I have observed the following changes in my blood sugar.
1. My weekly average fasting blood sugar is approximately 40 points lower than when I started.
2. I have eliminated Actos from my treatment regime.
3. When I eliminated Actos (which wasn't done as cleanly as I'd like) I saw roughly a 20 point rise in blood sugar
4. Presumably if I was still on Actos my blood sugars would be 20 points lower still, representing a 60 point drop. I'll concede this is totally inferred and is not based on actual data.
5. It appears my new diet (what I'm eating, not how little I eat - the noun, not the verb) is resulting in an average 5-6 point drop in blood sugar per week.
6. I have lost 28 pounds and my blood pressure has dropped to 132/62 (nominally) and I've reduced my medicine by 75%.
7. The effect on lipid chemistry is entirely unknown but I'm guessing the report I'll get at the end of the month will be good. Again, no data, just my opinion.
Looking forward I've done some modest research on the effect of metformin on blood sugar. One study looked at patients taking 500 mg, 1000 mg, 1500 mg, and 2000 mg of metformin daily. It found the reduction in serum blood sugar varied from 19 mg/dl to 82mg/dl, respectively. It also found that there was a correlation between BMI and the effect of metformin. The reduction in blood sugar was noted in people who were over-weight (BMI 25 or more) and obese (BMI 30 or more). No effect was notice in people with a BMI <25 (i.e., normal weight).
So, I'll discuss my plan with my doctor but the concept is this. When my weekly average fasting blood sugar approaches 110 mg/dl I'll drop my metformin dosage by 500 mg. That should keep my blood sugars in a safe range. I'm currently taking 2,000 mg of metformin daily; 1,000 mg morning and again in the evening. I'll cut the evening dose first because the time to the next dose is short - frankly, I don't think it will matter. I expect I'll start reducing metformin in 3-4 weeks, assuming my blood sugars continue to drop. I also expect to be able to make additional cuts in metformin every 3-4 weeks.
Looking ahead, I think I will be off blood pressure medicine entirely in the next few months (maybe sooner). Unless my rate of change in fasting blood sugar averages changes (and it could speed up or slow down), I think I'll be off metformin (my last blood sugar drug) in September or October. One reason I am considering the possibility of the rate of change increasing, is I have read where fasting can cause biochemical changes in how glucose is produced and metabolized. It appears fasting for 2 days (or more) can improve insulin response significantly. A 2 day fast would be interesting both biologically and religiously, and I think that's worth pondering.
1. My weekly average fasting blood sugar is approximately 40 points lower than when I started.
2. I have eliminated Actos from my treatment regime.
3. When I eliminated Actos (which wasn't done as cleanly as I'd like) I saw roughly a 20 point rise in blood sugar
4. Presumably if I was still on Actos my blood sugars would be 20 points lower still, representing a 60 point drop. I'll concede this is totally inferred and is not based on actual data.
5. It appears my new diet (what I'm eating, not how little I eat - the noun, not the verb) is resulting in an average 5-6 point drop in blood sugar per week.
6. I have lost 28 pounds and my blood pressure has dropped to 132/62 (nominally) and I've reduced my medicine by 75%.
7. The effect on lipid chemistry is entirely unknown but I'm guessing the report I'll get at the end of the month will be good. Again, no data, just my opinion.
Looking forward I've done some modest research on the effect of metformin on blood sugar. One study looked at patients taking 500 mg, 1000 mg, 1500 mg, and 2000 mg of metformin daily. It found the reduction in serum blood sugar varied from 19 mg/dl to 82mg/dl, respectively. It also found that there was a correlation between BMI and the effect of metformin. The reduction in blood sugar was noted in people who were over-weight (BMI 25 or more) and obese (BMI 30 or more). No effect was notice in people with a BMI <25 (i.e., normal weight).
So, I'll discuss my plan with my doctor but the concept is this. When my weekly average fasting blood sugar approaches 110 mg/dl I'll drop my metformin dosage by 500 mg. That should keep my blood sugars in a safe range. I'm currently taking 2,000 mg of metformin daily; 1,000 mg morning and again in the evening. I'll cut the evening dose first because the time to the next dose is short - frankly, I don't think it will matter. I expect I'll start reducing metformin in 3-4 weeks, assuming my blood sugars continue to drop. I also expect to be able to make additional cuts in metformin every 3-4 weeks.
Looking ahead, I think I will be off blood pressure medicine entirely in the next few months (maybe sooner). Unless my rate of change in fasting blood sugar averages changes (and it could speed up or slow down), I think I'll be off metformin (my last blood sugar drug) in September or October. One reason I am considering the possibility of the rate of change increasing, is I have read where fasting can cause biochemical changes in how glucose is produced and metabolized. It appears fasting for 2 days (or more) can improve insulin response significantly. A 2 day fast would be interesting both biologically and religiously, and I think that's worth pondering.
Wednesday, June 8, 2011
Stuck
I'm off Actos and my blood sugar has stabilized around 135 (morning fasting average). It had been dropping about 6 points per week. When I went from 45 mg of Actos daily to 22.5 mg daily, it continued to drop. After stopping it altogether, it rose about 20 points from 115 to 135. I occasionally get a reading in the teens or twenties but mostly they are running in the mid thirties.
There are a bunch of possibilities as to what's going on. My diet remains about 1450 calories daily of mostly vegetable based foods. Exercise has slacked of a bit due to company and travel. I have been getting exercise but not as vigorous as before. So the lack of exercise is one possibility. Another possibility is my body is readjusting to not having any Actos after better than 10 years. If this is the case I would expect to see the readings start to drop in a week or so. A third possibility is this is as far as I can go with diet and exercise. I'm not ready to accept this yet.
On the positive side, I still have about 50 lbs to lose and that will reduce fat interfering with my body's insulin production and it will hopefully reduce insulin resistance too. The first question is whether this will be enough to get me "diet controlled" and the immediate next question is whether or not I can achieve more reversal of the disease.
My plan is to be patient, start using the Nordic Track indoors to avoid the heat, and keep on reading. T
There are a bunch of possibilities as to what's going on. My diet remains about 1450 calories daily of mostly vegetable based foods. Exercise has slacked of a bit due to company and travel. I have been getting exercise but not as vigorous as before. So the lack of exercise is one possibility. Another possibility is my body is readjusting to not having any Actos after better than 10 years. If this is the case I would expect to see the readings start to drop in a week or so. A third possibility is this is as far as I can go with diet and exercise. I'm not ready to accept this yet.
On the positive side, I still have about 50 lbs to lose and that will reduce fat interfering with my body's insulin production and it will hopefully reduce insulin resistance too. The first question is whether this will be enough to get me "diet controlled" and the immediate next question is whether or not I can achieve more reversal of the disease.
My plan is to be patient, start using the Nordic Track indoors to avoid the heat, and keep on reading. T
Wednesday, June 1, 2011
The Details of Type II Diabetes
Disclaimer - I am not a physician. I have an MS in Environmental Biology and oddly, that degree may be the perfect one to really understand Type II diabetes. Some might argue that if your only tool is a hammer, then every problem looks like a nail and therefore, my environmental approach to solving the riddle of diabetes starts using the wrong tool. I would suggest the data supports me and to some extent, puts physicians in the role or using the wrong tools (weight loss and drugs) to deal with diabetes. The best these tools can do is stave off the inevitable progression of the "disease." Changing the environment can at least halt the progress of the disease, and a growing body of evidence suggests it can reverse the disease. How far the reversal can go has not been quantified.
Type II diabetes is a group of "conditions" (diseases?) where the body develops resistance to insulin and blood sugar levels rise. The pancreas is still producing insulin; perhaps even more than a person without Type II diabetes. When insulin production increases, it appears there's a risk of "burning out" the beta cells in the pancreas that produce insulin. This is currently understood to be irreversible but this may soon be reversible thanks to modern medicine. So control of blood sugar is important to a Type II diabetic. When enough of the insulin producing cells die off, insulin injections become necessary. Interestingly the ADA (American Diabetes Association) has different and more lax standards than the AACE (American Association of Clinical Endocrinologists). More on this in another post.
In the book The China Study T. Colin Campbell shows a rather convincing graph comparing diets in six or seven different countries. The data are about 50 years old but aligned perfectly with his findings. Where a low fat-high carbohydrate diet is consumed diabetes is almost non-existant. Yes I said high carbohydrate. He then goes on to show a near perfect linear relationship showing the incidence of diabetes increases as the ratio of fat to carbohydrates increases. If the advice you've been getting is like what I've been hearing, you probably thought carbs were bad for diabetics. Some are for sure, like refined sugars and white flour, but they are not the cause of diabetes. They simply raise your blood sugar and stress your pancreas. Complex carbs, like those found in plants, are actually good for diabetics.
The causative factor of diabetes seems to be fat. Moreover, the body's environmental response to fat is to conserve the energy. Prior to meat becoming a common and primary element of the diet, the response made perfect sense and aided the survival of the animal. Fat was stored both in the cells and on the body (frequently around the waist or the buttocks). The body's response to fat also included reducing the number of mitochondria within the cells of the body. The mitochondria are found in essentially every living cell of the body and are where energy is produced. The process is known as the Krebs-citric acid cycle and reduces ATP to ADP releasing energy, and uses glucose to "recharge" the ADP to ATP.
The Krebs-Citric acid cycle is complicated but well known. What is important to know is intracellular fat is long-term stored energy for the body to use later - perhaps months or years later. ADP is what the body uses to produce energy and it is quickly recharged using glucose. Glucose is taken from the easiest source - foods that have recently been ingested. When this is exhausted the body uses glycogen, and finally fat, but not directly. This is why you can significantly drop your blood sugar by exercising after eating. You are using the glucose that your body absorbed from your meal. It is also why exercise "burns" fat.
The problem comes when a person eats too much fat. The body automatically wants to conserve the fat (this is not the "starvation mode" dieters experience) and predictably, it responds to excessive amounts of fat with an excessive response. Two different things happen, both of which contribute to Type II diabetes. First, in order to conserve energy the body reduces the number of mitochondria within the cells. With all the fat energy there you don't need all the mitochondria producing energy. Fewer mitochondria allow a person to function without burning off the fat needlessly. Fewer mitochondria also reduces the bodies ability to burn glucose quickly. The result is a small, perhaps insignificant rise in blood sugar. The other thing that happens is the intracellular fat interferes with the ability of insulin to communicate with the cell and allow it to bring glucose into the cell. I'd speculate that the cell is saying, "I'm full" take your glucose to a cell that's still "hungry." The body is placing a limit on how much intracellular fat it will allow.
If this explanation is accurate, and I can cite quite a body of hard science (as opposed to whack-a-do-docs selling a diet plan), then diabetes is an environmental disease. There is a small but growing body of supporting research to suggest that the environmental changes are the result of epigenetic changes. DNA markers change in response to environmental conditions causing the changes that have been described. The good news then is changing the environment, may be able to utterly reverse the disease. This would be the cure for diabetes. Interestingly, it isn't a pill or a shot but a change in the environment - mainly a change in one's diet that results in a cure. Isn't it ironic that the most modern medicine can do is prolong the progression of the disease while the individual has the power to cure themselves?
Next time - Working on a Cure.
Type II diabetes is a group of "conditions" (diseases?) where the body develops resistance to insulin and blood sugar levels rise. The pancreas is still producing insulin; perhaps even more than a person without Type II diabetes. When insulin production increases, it appears there's a risk of "burning out" the beta cells in the pancreas that produce insulin. This is currently understood to be irreversible but this may soon be reversible thanks to modern medicine. So control of blood sugar is important to a Type II diabetic. When enough of the insulin producing cells die off, insulin injections become necessary. Interestingly the ADA (American Diabetes Association) has different and more lax standards than the AACE (American Association of Clinical Endocrinologists). More on this in another post.
In the book The China Study T. Colin Campbell shows a rather convincing graph comparing diets in six or seven different countries. The data are about 50 years old but aligned perfectly with his findings. Where a low fat-high carbohydrate diet is consumed diabetes is almost non-existant. Yes I said high carbohydrate. He then goes on to show a near perfect linear relationship showing the incidence of diabetes increases as the ratio of fat to carbohydrates increases. If the advice you've been getting is like what I've been hearing, you probably thought carbs were bad for diabetics. Some are for sure, like refined sugars and white flour, but they are not the cause of diabetes. They simply raise your blood sugar and stress your pancreas. Complex carbs, like those found in plants, are actually good for diabetics.
The causative factor of diabetes seems to be fat. Moreover, the body's environmental response to fat is to conserve the energy. Prior to meat becoming a common and primary element of the diet, the response made perfect sense and aided the survival of the animal. Fat was stored both in the cells and on the body (frequently around the waist or the buttocks). The body's response to fat also included reducing the number of mitochondria within the cells of the body. The mitochondria are found in essentially every living cell of the body and are where energy is produced. The process is known as the Krebs-citric acid cycle and reduces ATP to ADP releasing energy, and uses glucose to "recharge" the ADP to ATP.
The Krebs-Citric acid cycle is complicated but well known. What is important to know is intracellular fat is long-term stored energy for the body to use later - perhaps months or years later. ADP is what the body uses to produce energy and it is quickly recharged using glucose. Glucose is taken from the easiest source - foods that have recently been ingested. When this is exhausted the body uses glycogen, and finally fat, but not directly. This is why you can significantly drop your blood sugar by exercising after eating. You are using the glucose that your body absorbed from your meal. It is also why exercise "burns" fat.
The problem comes when a person eats too much fat. The body automatically wants to conserve the fat (this is not the "starvation mode" dieters experience) and predictably, it responds to excessive amounts of fat with an excessive response. Two different things happen, both of which contribute to Type II diabetes. First, in order to conserve energy the body reduces the number of mitochondria within the cells. With all the fat energy there you don't need all the mitochondria producing energy. Fewer mitochondria allow a person to function without burning off the fat needlessly. Fewer mitochondria also reduces the bodies ability to burn glucose quickly. The result is a small, perhaps insignificant rise in blood sugar. The other thing that happens is the intracellular fat interferes with the ability of insulin to communicate with the cell and allow it to bring glucose into the cell. I'd speculate that the cell is saying, "I'm full" take your glucose to a cell that's still "hungry." The body is placing a limit on how much intracellular fat it will allow.
If this explanation is accurate, and I can cite quite a body of hard science (as opposed to whack-a-do-docs selling a diet plan), then diabetes is an environmental disease. There is a small but growing body of supporting research to suggest that the environmental changes are the result of epigenetic changes. DNA markers change in response to environmental conditions causing the changes that have been described. The good news then is changing the environment, may be able to utterly reverse the disease. This would be the cure for diabetes. Interestingly, it isn't a pill or a shot but a change in the environment - mainly a change in one's diet that results in a cure. Isn't it ironic that the most modern medicine can do is prolong the progression of the disease while the individual has the power to cure themselves?
Next time - Working on a Cure.
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