Monday, March 13, 2006

Diabetes and the Cosmos

For a long time I’ve been fascinated by the puzzle of how it is that each of us is who we are. Because my basic college education was in theatre, I’ve taken a humanities approach to a person: the inner thought, the cultural influences, and so on. This has been pretty much an advantage, since it gave me a sympathy and viewpoint that didn’t mean being patronizing or controlling. To the more scientific or mechanistic types, I was often unexpected. One of the basic assumptions of the humanities -- that humans are unendingly complex and surprising -- kept me from being too dogmatic or too worried about being self-disclosing, since by the time people read and understood what I said about who I was -- I was already gone on to something else.

And so it has been as I explore diabetes. This metabolic disorder is not part of me, it IS me. It is the power of my thought, the limits of my endurance, and maybe the length of my life. Therefore, it’s a pretty fascinating subject.

What’s more, it connects me to the whole Blackfeet tribe as they struggle with this phenomenon, but it separates me from all those who still eat in a way that produces diabetes, and it raises political issues about why corporations are allowed to treat diabetes as a marketing opportunity by preventing change in both food and medicine. Their idea is to invent medicines that will keep us eating things that are bad for us in the first place, instead of just returning to older habits.

Doing the things I need to do to stay healthy also puts me out of sync with many social patterns. My friends like to eat late, go to bed with full stomachs (I have acid reflux, which means I’ll soon wake up miserable), drink wine, and eat wonderful desserts. On the occasions when they are doing this, they talk about exactly the sort of fabulous humanist ideas that I love most. I hate sitting at the table with celery and club soda, yawning, just so I can share the talk. This is another way the Internet has enriched me -- the conversation at the computer table goes on in print all the time.

This, of course, connects me to genetics and the amazing ideas coming out of the study of humans in the paleolithic and after. We’re not just talking about the American obsession with monocropped corn, we’re talking about the original conflict between Cain, the animal guy, and Abel, the plantsman: Abel being the one that developed when the glaciers withdrew, evoking agricultural and cities. Jacob and Esau, a reiteration, as I see it. (Even today, the Jadaweed herdsmen swoop down on the villages who depend on small gardens.)

And that, in turn, engages me in reading about proteomics, the study of the proteins that genes make, turning them on and off, using what elements are at hand, creating a human from a little egg and sperm and then operating it like a spaceship: turning the burners on and off, shaping the hull and engines, allowing hitch-hikers whether benign, co-dependent, or hostile, guiding the “ship” through the world with greater or lesser success.

That’s all very fancy. Let’s look at the “concrete.” I am my own research project, sticking my finger and testing blood four times a day. (Most people do twice.) The tips of my fingers are looking like colanders, but finger sticks are not as bad as I thought, mostly due to the invention of a little spring-loaded instrument that only makes a hole the right size to get a bead of blood that fits on the little tab that goes into the machine. This is FAR better than the old diabetes test, which was a stick to hold in the urine stream like today’s pregnancy test. This modern method is pretty accurate and only takes a minute -- 45 seconds after the blood is put on the little tab.

The harder part is getting a handle on what the scores mean. Some say that 80 to 120 is “normal” but all the literature says that one’s doctor must define one’s own ideal range of scores. My own doctor just said to call her if I go over 300 for several readings in a row. I’ve barely gone over 200 a few times. Mostly I score somewhere around 130 with dips as far as 80. (Oddly, that’s my most usual blood pressure as well. What can THAT mean?) I can’t predict -- times I think I’ve eaten all the right things don’t correlate, but exercise always brings the score down. I figure a quick jaunt around the nearby park drops the score between ten to twenty points.

Other things are very subtle. The ghost of my menstrual cycle (I’m 66 years old) is there: at the time PMS would have been, my scores are high. Is this one of the contributors to PMS? Or is there something in the hormone predominant at that time that resists insulin? If I have strong emotion -- anger, fatigue, excitement -- it affects my scores. (The happier I am, the “normaller” they are. Or is it the blood sugar level that is tripping the emotion?) I have not craved sugar or chocolate. I HAVE craved fats. (I’m losing weight on purpose. Close to 20# so far.)

The literature is full of amazing things. One is that insulin is secreted in the brain as well as the pancreas. (Diabetes makes you dumb?) The brain is one of the big glucose-users, so I guess it makes sense. If you have more or less insulin in your brain, are you a better or worse thinker? Does your thinking ability go up and down according to brain insulin, independent of the pancreas and general digestion? It seems that low brain insulin is related to Alzheimer’s -- but which causes which?

Diabetes is actually not just a shortage of diabetes but also the inability of a cell to accept and use it. Some meds kick up the Isles of Langerhans so you make more insulin (some argue that this is not a good thing because you can “wear out” the Isles) and other meds (Metformin) encourage the cells to receive the insulin. I started out taking both kinds of med, which dropped my blood sugar down so low I was incoherent. Now I’m not taking any diabetes med, but I’m taking blood pressure medicine.

It seems clear that blood pressure is somehow related to diabetes, but no one knows quite how it works. I had been taking spirolactone as my blood pressure med, but it works by being a diuretic, wringing out water from the body so there is a smaller volume of blood circulating. But if I went on a high old chocolate binge (been known to do that) it would be very possible that I could increase the sugar content of this reduced-volume blood so far that it became thick as syrup and wouldn’t circulate properly anymore. What really brought this home to me was the website which said that if the above pertains, “get to a doctor as fast as possible. Get someone else to drive as you will soon not be able.”

I guess a lot of people know that there are two types of diabetes: I and II, but now -- rather like hepatitis -- there are beginning to be third types, though there is not agreement on what the third category means. One version is that Diabetes III is when you’ve had Type I, or “juvenile,” for long enough, the many doses of insulin (esp. if the person feels free to eat almost anything so long as it’s balanced with the proper amount of insulin) will cause that person to develop Type II diabetes, producing what they call “Type III.” But others refer to Type III as the type produced when a brain stops making insulin. (They don’t say how this differs in symptoms or how they can tell if the pancreas is still functioning.)

I was surprised that the ADA was so resistant to low-glycemic diets until I realized that it meant that the corporations who produced “ADA approved” foods that look like beloved but high glycemic foods would withdraw their support unless this view were maintained. Thanks to the Internet, I go right over their heads to Austrailian websites, which admire low glycemic theory. My handyman lost a lot of weight by making a list of everything he ate, looking up their calorie content, and crossing off the five highest foods. (He said potato chips were at the head of the list.) One can do something equally effective by making the same list and then looking up their glycemic values -- and crossing off the five highest foods!

Some frame the problem of Type II diabetes/weight loss and so on as a premature aging problem: the idea is that we either have clinkers in our systems (these are the anti-oxidant theorists) or that we simply aren’t getting the nutrients we need (the supplement theorists). Diabetes is linked with high cholesteral as well as high blood pressure as well as just being fat. When you get into this area, plenty of people have miracle meds to offer, all the way from familiar vitamins to substances that are Germanic in their multisyllabalism and impossible to sort out in terms of interactions and efficacy. Most are untested -- just theoretical.

And no one wants to think about environmental contamination, whether something in the air, the water, the food, the cleaning materials, or the teflon on our pans.

Another interesting suggestion is that getting the proper amount of sleep correlates with the incidence of diabetes -- it has to be enough but not too much, it’s highly individual, and no one knows whether sleeplessness makes you diabetic or sleep knits up the raveled sleeve of glucose metabolism.

I’m just thrilled that I can lose weight, read (again -- oh, blessed eyes!), walk and eat at least some things that I like. Or is it that I like them because I can eat them with no bad effects? So long as it’s not late at night and I’m not also drinking wine.


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