Sunday Stories of Low Carb – June

Sunday Stories and 23 Jazz Concerts!

(1) Interview (about 13 minutes) on NEquals1Health.com among 2 couples regarding their experiences with the benefits of low-carb nutrition. LINK

(2) Gary Noreen, of Low Carb Review (lcreview.org), has written the story of his 19 years of controlling Type 2 diabetes with a low carb diet:

http://lcreview.org/main/my-story/

“They made the mistake of giving me a glucometer (blood glucose meter). I quickly found that eating cereal and skim milk for breakfast along with a banana made my glucose take off like a rocket. “Artery-clogging” eggs and bacon had no effect. This was bewildering.

Fortunately for me, the only Type 2 diabetes book in my local library was Diabetes Type II: Living a Long, Healthy Life Through Blood Sugar Normalization by Dr. Richard Bernstein, who recommended a very low carbohydrate diet (30 gm/day) and no restrictions on fat except no trans fats. Dr. Bernstein’s very low carb diet quickly brought my blood glucose under control and dramatically improved my lipid measurements. 19 years later, I have never needed to inject insulin, my most recent A1c measurement was 5.6%, I have no diabetes complications, and my lipids are excellent.”

His story is much longer than the quote above, and he includes his lab test results and details of his medications and how he manages his health.  Note that after 19 years since diagnosis, and with sky-high blood glucose at diagnosis, he reports “I have no diabetes complications”.

Sunday Music

The CBC (The Canadian Broadcasting Corporation) is Canada’s public broadcasting corporation and the radio is commercial-free. They maintain a very extensive website.

www.cbc.ca/radio

One of their features is CBC Music, with multiple genre streams and tons of “concert on demand” recordings.

This link is to a page featuring over 20 jazz concerts.  LINK

Lottttsss of Sunday Music!

Impact of high blood glucose on vascular events and death

This study is just published.  When looking at this study, there are four key factors to consider:

  • This is a study that looks at correlation, it does not specifically test cause. People who had evidence of sustained exposure to higher blood glucose levels had worse outcomes, for whatever mix of reasons.
  • This study did not look at micro-vascular disease (such as nerve damage, kidney damage or eye damage) or rate of deterioration of glucose control, so the study does not say that there might not be health benefit from achieving a HgA1c of less than 6.5%
  • I’ll have to wait to see the full text of the study (and consider input from others who will doubtless publish commentary) to consider what further might be said of this study. For example, the fact that the results of the study did not suggest a protective effect from having HgA1C below 6.5% could be related to low numbers of the study group reaching such a relatively good level of control – although this was probably accounted for. Only further examination of the full study report will tell.
  • Also, HgA1C is only one way of looking at blood glucose levels.  It does not give information about aspects of blood glucose that vary between people, such as the degree of elevation of fasting glucose versus glucose spikes after meals.
Diabetologia. 2012 May 26.

Relationship between HbA(1c) levels and risk of cardiovascular adverse outcomes and all-cause mortality in overweight and obese cardiovascular high-risk women and men with type 2 diabetes.

Department of Cardiology, Gentofte University Hospital of Copenhagen, Niels Andersens vej 65, 2900, Hellerup, Denmark, ca@heart.dk.

Abstract

AIMS/HYPOTHESIS:

The optimal HbA(1c) concentration for prevention of macrovascular complications and deaths in obese cardiovascular high-risk patients with type 2 diabetes remains to be established and was therefore studied in this post hoc analysis of the Sibutramine Cardiovascular OUTcomes (SCOUT) trial, which enrolled overweight and obese patients with type 2 diabetes and/or cardiovascular disease.

METHODS:

HRs for meeting the primary endpoint (nonfatal myocardial infarction, nonfatal stroke, resuscitated cardiac arrest or cardiovascular death) and all-cause mortality were analysed using Cox regression models.

RESULTS:

Of 8,252 patients with type 2 diabetes included in SCOUT, 7,479 had measurements of HbA(1c) available at baseline (i.e. study randomisation). Median age was 62 years (range 51-86 years), median BMI was 34.0 kg/m(2) (24.8-65.1 kg/m(2)) and 44% were women. The median HbA(1c) concentration was 7.2% (3.8-15.9%) (55 mmol/l [18-150 mmol/l]) and median diabetes duration was 7 years (0-57 years). For each 1 percentage point HbA(1c) increase, the adjusted HR for the primary endpoint was 1.17 (95% CI 1.11, 1.23); no differential sex effect was observed (p = 0.12 for interaction). In contrast, the risk of all-cause mortality was found to be greater in women than in men: HR 1.22 (1.10, 1.34) vs 1.12 (1.04, 1.20) for each 1 percentage point HbA(1c) increase (p = 0.02 for interaction). There was no evidence of increased risk associated with HbA(1c) ≤6.4% (≤46 mmol/l). Glucose-lowering treatment regimens, diabetes duration or a history of cardiovascular disease did not modify the associations.

CONCLUSIONS/INTERPRETATION:

In overweight, cardiovascular high-risk patients with type 2 diabetes, increasing HbA(1c) concentrations were associated with increasing risks of cardiovascular adverse outcomes and all-cause mortality.

PMID: 22638548

Do you know where your blood sugar climbs after eating?  BloodSugar101.com

Diabetes – Not Just Type 1 and Type 2 Anymore

English: Diagram shows insulin release from th...

English: Diagram shows insulin release from the Pancreas and how this lowers blood sugar levels. (Photo credit: Wikipedia)

Need for Wider Recognition of Non-Classic Forms of Diabetes

Almost all discussion of diabetes revolves around what are called Type 1 diabetes and Type 2 diabetes.  Type 1 diabetes is the term used when there is a very low or absent production of insulin, due to destruction of the type of cells in the pancreas that make insulin.  Classically, this onsets in childhood and is the result of an immune attack on those cells.  The term is also used when those cells are destroyed by other processes.  An example would be repeated or severe bouts of pancreatitis (inflammation of the pancreas), which may bring a great deal of pancreatic tissue destruction.

Type 2 diabetes is the term used when the amount of insulin being produced is as much (or more) as would normally be needed to do its job, but the blood glucose is high because the signal of the insulin is not being recognised properly at the level of the cells – most prominently, in terms of blood sugar levels, the muscle cells and the liver.  The cells are “resistant to insulin”, and the person has “insulin resistance”.  The insulin production is higher than normal, but not high enough to keep blood glucose in the normal range, die to cells not responding properly to the insulin.

These two types can also get mixed up together.  A person with Type 1 diabetes (not able to produce enough or any insulin) can also becomes resistant to insulin, which would mean that they need higher amounts of insulin to keep their blood sugar controlled.  Someone with Type 2 diabetes can, over time, have a gradual destruction of their ability to make insulin, becoming more like a Type 1 diabetic.

It turns out there is more to the story.  There is also MODY and LADA.  It turns out that these need to be included more in our awareness.  The term “MODY” is an acronym for “Maturity Onset Diabetes of the Young” and “LADA” is an acronym for “Latent Autoimmune Diabetes of Adults”.

For an explanation of these, I refer you to Jenny Ruhl’s site, BloodSugar101.com.

Keep in mind as you read these two articles that our present understanding of both LADA and MODY is not well developed. More research will fill in gaps in our knowledge, so it is to be expected that the known facts and the concepts will develop over time.

From Diabetes in Control comes an article discussing new findings about LADA:

AACE: Latent Autoimmune Diabetes in Adults often Misdiagnosed

Almost half of nonobese adult with poorly controlled diabetes have latent autoimmune diabetes that has been misdiagnosed as type 2 diabetes….

Ankit Shrivastav, MD, from the Institute of Postgraduate Medical Education and Research in Kolkata, India, said that, “Young, nonobese, adult-onset diabetic patients with a negative family history, a rapid deterioration of glycemic control, and a rapid onset of complications should be screened for autoantibodies.”

Here is a recent article about MODY:

“Systematic Assessment of Etiology in Adults With a Clinical Diagnosis of Young-Onset Type 2 Diabetes Is a Successful Strategy for Identifying Maturity-Onset Diabetes of the Young”

It is time for these two other forms of diabetes, which had been thought of as uncommon, to be included more generally in our thinking and our approach.

Short Link for this article http://wp.me/p2jTRh-9Z