Saturday, July 4, 2009

Get with the program

This is part three of a series of non-consecutive posts which attempt to explain in the simplest of terms the nature of a disease called diabetes mellitus.

Those of you who read the previous post on this subject will remember that an important hormone called insulin is needed in order to "escort" glucose molecules through cell membranes. Most cells. An important exception are muscle cells which have the ability to uptake glucose without the presence of insulin. As I am so fond of saying, more on that later.

Right now I would like to introduce a new fact: insulin has another function besides running an escort service. Insulin's other job is turning sugar into fat for storage.

Up until now, I have avoided using the word "sugar" because most people think of white table sugar when they see the word. Admittedly, everyone - including doctors - lazily say things like "Your blood sugar level is too high, Mabel. You need to cut down on the banana cream pie." Or such. Or, "I check my blood sugar level 11 times a day, by god." Or, "If your sugar level gets too low you will pass out right on the street, Milly."

What all of these things REALLY mean is your GLUCOSE level is too high, or was checked 11 times, or it may get too low. There are many types of sugars. We eat them. Dextrose. Fructose. Maltose. Lactose. YadaYada. But when the digestive juices have run their course and the fat lady has sung (that is probably an inappropriate thing to say in a diabetes post) and when the rubber meets the road, it is the simple sugar called GLUCOSE, which has been "distilled" out of everything carbohydrate, which is now coursing through your bloodstream.

Glucose. On the loose. Yearning to breathe free. Looking for an insulin molecule to bind onto and ride the wild surf in search of a hungry cell. Something like that. But let's face it: often, there is much more glucose in your bloodstream than even a brontosaur would ever need. Especially the bloodstreams of those of us who enjoy moist German chocolate cake with whipped cream on top. What then?

"What then" is that the insulin facilitates the chemical changing of the extra glucose into fat, and your body stores that fat in specialized cells called adipose cells and a giant magnet attracts them to your ass. In a picturesque, if somewhat incomplete, manner of speaking.

Adipose cells are wondrous things which enabled our caveman ancestors to survive, and deserve to be spoken of more completely elsewhere. I'm sure they will be.

But, all joking aside, being obese is not all that it is cracked up to be, and hasn't been since our caveman ancestors had to go without eating for a couple weeks at at a time. You don't. You eat every single week. You eat every single day. You eat 3 times a day. You eat...

Well, you get the picture.

Ever wonder why the truck stops serve huge platters of food to truck drivers, as if they were lumberjacks instead of Jabba-the-Hutts who can barely squeeze behind the steering wheel of their truck so they can sit on their behind all day and and listen to country music on the stereo and cut you off in traffic and go up long hills side by side? I have never figured that out either. I DO know a ton (even more) of truck drivers have Type II Diabetes.

All this is to say that obesity begets insulin resistance. So your first mission to take on, if you want to survive the onset of your diabetes, is to lose your ass. Exercise. Eat protein. Forgo the sugar. Walk. Lift weights. Eat chicken. Walk some more.

Lose the weight and you will lose the insulin resistance your cells have built up. The damage done by all your tissues soaking in a sea of sickly sweet sugar over the years CAN be reversed to a large extent. And the less sugar you eat, the less will be extra that can and will be turned into fat. Are you a marathon runner by trade? No? Then carbs are the enemy.

It is truly a vicious cycle: your cells don't get the nourishment they need, so you feel hungry. You eat. And you eat. And all that sugar turns to fat and you gain weight and your insulin resistance increases and even less glucose is allowed into your cells and so you feel hungry and you eat. Okay, I will stop. You get the picture.

If you are obese, or quickly becoming so, don't wonder if you are becoming diabetic. I assure you, you are - simply because obesity promotes insulin resistance. In fact, there is a really good chance that the reason you are obese in the first place is because you are becoming insulin-resistant. Well, that and all the damn pie. The chance of you having an out of whack thyroid is too slim to contemplate. But have a thyroid-function blood test anyway. Why not? - since you already have the blood drawn for other tests anyway. As Forest Gump might say, "One less thing."

Don't believe me? Do yourself a favor and start checking your blood glucose levels. Make it a habit. A meter is non-prescription and can be bought at Walgreens for under $25. The test strips cost more, but you don't have to test 11 times a day (that was an exageration.) Go ahead - I dare you to find out. Test your blood first thing in the morning when you get up once, after you haven't eaten anything all night. Or go have that big piece of pie and then test a half hour to 45 minutes later. Then, more importantly, how long does it take to come back down? Test again two hours later. Four hours later?

Don't be afraid to find out. Know your enemy.

More to follow.

Special note to diabetics who are injecting insulin or who are taking prescription drugs of the sulfonylurea class (such as Glipizide or Glyburide): Do NOT begin a strenuous exercise program or begin a high protein - low carb diet without adjusting your insulin dosage or your oral meds dosage. Consult with your physician before doing any of the things in this post, and learn what adjustments need to be made to the quantities of your medications. Be mindful that if you are injecting insulin or taking sulfonylurea meds, or both, you CAN induce hypoglycemia by changing your exercise and/or diet patterns without also adjusting your dosages. But you already know that, and are too smart to make changes in diet and exercise without experimenting little by little and testing constantly with each step. Aren't you?

If you are not on diabetic medication, or if you are only taking prescription Metformin, you are not going to go hypo. Still, a wise person would start an exercise regimen, or a new diet, gradually and should STILL consult with their physician to make sure they are fit enough for the program contemplated. If you stick to it and lose weight and increase your skeletal muscle mass, you will surely be rewarded by needing to inject less insulin.


  1. Make a habit of testing my blood sugar levels? Doesn't it hurt? Every day? How much blood would that be - a fingerful a week? No thank you. I'm not overweight medically speaking, I'm not too sedentary though could do better. I do get hungry though.....

  2. I do and don't yet have a blood sugar problem. But I also know, if I don't do something today, I will.

    Knee damage does, however, complicate the exercise issue.

  3. What a good informational post Max. My maternal grandmother had diabetes and I learned very early the havoc it wreaks on the body. Of course that was many years ago before a lot was known. She was blind as a result for as long as I remember. People do not die from diabetes but from the damage it causes to the organs

  4. @A. - Thank you for reminding me that EVERYONE doesn't have to test. Only those at risk, with the symptoms, should. No, not every day. Once. Are you trying to make trouble. Anyway, you need to squeeze out about a pint and it usually hurts so bad you need general anesthesia. Go away. :)

    @Stephanie B - I wish more people were aware like you are. So many aren't. Think hard about the exercise bit. I know you can come up with something. :)

    @Ettarose - Hello stranger. Yes, all blood vessels are at risk. It is a good idea to have your eye doctor check for leakage. You don't have to have your pupils dilated anymore to do it either. They can take a picture and show you on a computer screen. Just when you get your eyes checked.



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