Returned

I must reiterate the sentiments of the famous blogger Ben Awhile. You know the script: I can't believe it's been this long since I blogged...things are busy, going good with my diabetes, learning more how to manage the low carb way, wondering if I should cut back on my 6-7x/day testing, yada, yada. I've been blogging occasionally on my Diabetes Daily blog, so if you're interested in my diabetes journaling, you can read more there.

I have a few ideas about controversial subjects to blog about here, but just don't have the motivation to finalize them. Supplements, Statins, Cholesterol...maybe someday. Since I know these topics will most likely be addressed in my usual, non-succinct manner, it seems a bit daunting to get started.

It does amaze me, however, to see some (who use common sense, conservative approaches to diabetes management and diet) lose that sense when it comes to political ideas by embracing ideas that boil down to the thinking that those who earn money (whatever the amount) are obligated to give it to those who don't. Apparently, finding proof that someone doesn't have a license is more important than the fact that government wants to extract from its citizens more than what it needs to operate necessary functions and instead play the arbiter of who gets money and how much. Freedom means you keep what you earn and have access to possesses individual property. It is not freedom if the government can extract my individual earnings and property and distribute it to anyone--including fraudulent voter registration organizations.

On Display and Good Intentions

As you can see, my frequency in posting is few and far in between. It would be a pretty rare occurrence even if I only had one blog I was pretending to maintain, but for three it is definitely sluggish. I thought I'd submit this blog to the Diabetes Daily blogroll, and now am not sure that all the controversial content will be of much interest there. Oh well, I may have the right of free speech, but I definitely don't have the right to be heard!

Anyway, I came across this cartoon on one of the daily feeds and it struck me how well it illustrated what I've been doing with diabetes and thinking of blogging/journaling about. Not much has changed as far as management or results lately. However, I have been trying a variety of easy, low-carb recipes which have been tasty. They haven't affected my blood sugar that much, but I'm sure I'm getting more than my base calories in the extra protein and fats. In order to maintain an interesting variety on this way of eating, I intended to keep these recipes and probably make them often.

The cartoon was from Cartoonbank.com by Zachary Kanin. Man at a party is saying to a woman, "The key to being a writer is to take all the sadness and turmoil deep in the center of your being and channel it into a diet cookbook."

The Road Less Traveled

I have been pondering lately the fact that I often take as my personal set of beliefs those that are considered a minority opinion. Take my diet approach to diabetes, for example. The ADA has only considered low-carb diets as a short-term answer to weight loss, but has also informed Dr Bernstein in a letter that his books have been banned. Even compliant diabetics, who often acknowledge the need to eat less carbs than the ADA typically recommends, will often view Dr. Bernstein's way of eating as extreme and dangerous.



These "minority" beliefs and opinions of mine extend into the theological realm as well. I believe in a God in control of everything as described in the Bible, including the origin of the universe as we know it. I believe that the universe is not in its original state and that the earth was also affected by a global flood catastrophe. I believe that we know God through an understanding of His Word, the Scripture alone, and not through human commentary or mystical feelings, chants, or experiences or in some vague belief in a greater being or beings "out there." I believe that the most accurate written revelation of God is found in the Received Text. I believe that God's love and Christ's death is for His children only, and that everything happens for His glory and their good. I believe in the permanency of marriage and therefore believe that remarriage while the other spouse is living is always a violation of God's law. I believe in the complete sufficiency of Christ to pay for my offenses against God and believe that Christ's kingdom in which He rules over His subjects is a spiritual kingdom, not earthly. I mention some of these specifics to create a background for some of the topics I will eventually discuss and to illustrate that I am in the minority opinion with these views even among much of Christendom.



As my worldview sprouts from the previous base of beliefs, I consequently find that many of my social opinions are also among the minority. For instance, I believe that labor unions are a rebellion against the authority that God places over us and refused to join one when I worked in a "union shop." Since I believe that God made and also sustains the entire universe, I believe that so-called "global warming" is nothing more than political hype designed to abscond wealth. I believe that able-bodied humans should work for a living or receive help from their family and/or church, not the government. I believe that since God is perfectly able to supply our "daily needs" as we ask them of Him, we are not "entitled" to be in perfect health, nor have other taxpayers pay for all our health care. If He grants the wherewithal to treat disease and illness it should be utilized responsibly as with all that He gives. I don't believe death is the end of all things and therefore if using His gifts responsibly results in death, the destination of those He loves is far better than preserving life at all costs in this imperfect world. I believe that children are a blessing given by God and not to be "budgeted" through contraception or abortion. I believe God has given adequate resources for the number of humans He has determined will live on the earth at any given time and therefore disagree with the "overpopulation" myth. I believe that the primary responsibility for the education of children rests with the parents, not the government. Though it is perfectly legitimate to delegate such educational tasks to others, the parents are still ultimately accountable and responsible for the content of the child's education and must answer to their (and their child's) Maker for those choices.



In contrast, the alternative majority opinion has the uninformed eating large amounts of "healthy" carbohydrate foods that still convert to glucose--and then struggling with large doses of more and more medications to gain some semblance of control. On other fronts, it has humans thinking that we merely came to be without purpose--no antidote for depression there. It has many devaluing children in all stages of development and worshipping the earth and its resources instead of the Maker. It offers no ultimate hope for deliverance from the imperfections of this world as evidenced by the continuous, unsuccessful attempts for cures and peace.



You can get an idea, now, why I introduced this blog site as being on the controversial side. It is from this bias that I will be commenting on the issues and posting under these assumptions. While many disagree with these beliefs that I hold to be true, I have personally found them a great source of comfort, hope, understanding, truth, wisdom, and in the case of the diabetes--superior and positive management. I have the confidence of friendship with my Maker and know that this life's events are designed for my benefit. I can echo Robert Frost. I traveled the road not taken, and that has made all the difference.

Vici Diabeti

Studying for Lab Tests

In addition to all that I posted about my fortunes in connection with diabetes, I was also fortunate to get through school and college with very minimal effort on my part.

As a side note: Though some think it should be taken with a grain of salt being a community college, I breezed through most of my associate of applied science degree in nursing classes with a 4.0. I finally got a bit apathetic in my last semester and ended up somewhere around 3.85--still enough to finish at the top of my class (stiff competition, I know, but I also aced a bachelor's level Pathophysiology and Nursing assessment class).

Occasionally in the diabetic OC, you hear someone posit the advice to "give yourself a break sometimes." The idea is not to be so caught up in the nitty-gritty details--along with the wide fluctuations so common in diabetes--that you overstress yourself and burn out. My personal opinion is that this is usually spoken in the face of poor or unpredictable control. If what you're doing is giving you stable, excellent control, why do you need (or want) to "take a break" from it?

But, to prove that I am open-minded, I decided to follow this advice to an extent. There has also been a contentious debate which I've been mulling over which goes: Why does a non-compliant, type 2--on oral meds only--need to test often? What changes because of the frequent testing? Why are doctors prescribing and insurances pay (or pharmacies absorbing cost) for expensive meter strips if the diabetic doesn't follow any other of the doctor's advice? Of course, this question got all the compliant type 2s buzzing like bees! My own doctor is quite conservative when I ask for more strips than the four a day he allows me. The reason for frequent testing in a type 2 only on oral medication is to allow modifications of diet and exercise and possibly medication to prevent the poor control as well as gaining a background understanding of how the body will respond to all three factors under many different scenarios. If we only tested a fasting once a week, or an occasional post-meal reading, we could be missing a lot of harmful spiking (i.e., over 100-120 mg/dL) which even the A1c can miss.

But, on the other hand, I must say that other than testing different types of foods occasionally, and just recently making a change in exercise scheduling, I haven't done much modification at all. Most of my testing has been the automatic, because it's-what-I-do mode testing. I have a limited menu repertoire and tend to stick to it. So a couple days ago, before I had my labs drawn, I decided I would take a break from testing. A break from testing for me meant that I did a fasting, and then didn't test until just before exercise that afternoon. This was the time when I would usually see a rise in my blood glucose--probably my 4 hour spike from lunch, or my AM metformin or effects of previous day's exercise wearing off. Otherwise, I had no idea how my meals affected me that day.

It was sorta nice to not really act diabetic; but I, of course, didn't drop the whole diabetic outlook on life or control over my diet and exercise. Had I done that, and made it a pattern, I probably would have ended up with worse results than not studying much in my last semester of college. Taking a break from the diabetic curriculum can lead to disastrous complications. My break from testing didn't affect the next day's lab tests, except eating 6 eggs the day before instead of my usual 2 may have affected my less than desirable lipid panel. We'll see what the long-term shows on that.

It was nice to have a brief respite. I may well try it again. I was pretty confident that since my routine and diet were unchanged, I wouldn't be missing any blood sugar surprises. I must confess that I did feel guilty when I realized that my testing break would be affecting my data. How could I suppose that two random readings were an accurate reflection of the day's average? Oh well, I discovered the next day that my regular meter logging is definitely below my A1c anyway.

Epilogue: I more than made up for my break in the days after my labs were done. Being puzzled by the 5.3% A1c (106-111 average blood glucose) I got when my meter averages have been showing mid 80s to 90s consistently as average readings and because I got up much earlier than usual, I decided to test hourly and see if I was missing sustained higher levels of blood glucose. As a result, I did find that I spiked to the mid 90s on my meter at four hours after breakfast, so maybe that's what I've been missing. This wasn't a sustained spike that should have much impact on the A1c, however. I've done a similar experiment today, only I substituted my breakfast carbs from a can of mushrooms for a serving of spinach (as well as some low carb, home-made, sugar-free dark chocolate) and didn't see a spike all morning. I stayed in the low to mid 80's on my meter. Testing can be tiresome, but it also gives some valuable information. It's definitely a test worth studying and knowing the answers for.

Fortunately...

Had I been given the opportunity to consult in the grand scheme of my life events, I would most likely have not decided to take on a chronic disease such as type 2 diabetes mellitus as one of the enriching experiences through which I should go. However, since I have little say in such matters, I can only consider how fortunate I am that diabetes has befallen me--and at this point in my life.

I am fortunate that it was caught so soon--before devastating complications have apparently taken hold. I am fortunate that, apart from diabetes, I am otherwise healthy--I don't have other conditions complicating the original disease process. I am fortunate that obesity has not been a key struggle for me as it is so often with this disease (e.g. a grandparent)--my diet and exercise have me at the low end of a normal BMI. I am fortunate to have the training of my profession to give me a solid understanding of the disease and its treatment--as well as a healthy respect for its potential dangers. I am fortunate that my body has responded so well to a low carb diet, exercise, and metformin as readily as it has--hopefully this has preserved some beta cell function and stopped or reversed the otherwise inevitable progression so common with this disease. I am fortunate that I don't have to struggle with dawn phenomenon that many diabetics deal with. I am fortunate to have such a supportive, loving wife to make my dietary adjustments to planning so much simpler than it often can be. I am fortunate to have the resources to investigate the best treatment plan and then test the results as needed. I am fortunate that I've grown up with a healthy understanding of self-denial and the will to embrace it with regard to the dietary restrictions necessary to gain control of my blood sugars on this treatment regimen.

Having discovered this way of eating, I am fortunate to have such flexibility with eating--I don't have problems if I don't eat at certain times. I am fortunate to have a simple carbohydrate plan in the types and amounts. I am fortunate not to be riding the roller coaster of going high, dropping low, and experiencing all the yucky feeling that accompanies such swings. I am also fortunate that my body is producing enough insulin to cover the amount of carbs I eat--trying to be a pancreas with injected insulin is a mountainous challenge.

In summary, I am fortunate that I wasn't the one choosing which life experiences would be a part of my path, and that the One Who was responsible gave me my functioning pancreas as well as my diabetes out of a desire to make me a better person. I definitely can't take credit for being able to say (almost effortlessly it seems), "Vici diabeti."

Vici Diabeti

(Editor's note: So launches yet another blog for me to maintain sporadically. I'm a bit of a computer nerd, and I like trying new things out computer-wise. This makes blog site #3, so hopefully no one will have high expectations of regularly supplied content.)

Vici Diabeti. The title is derived from Napoleon's famous statement, "Veni, Vidi, Vici" (I came, I saw, I conquered.) Apart from sadly butchering Latin, of which I have practically no knowledge, you will most likely find this blog on the controversial side--at least often expressing a minority opinion and view of diabetes as well as life.

Obviously, without a known cure for either type of diabetes yet, cured of diabetes is not what "Vici Diabeti" refers to. However, in the last 5 months, I have been able to maintain normal blood sugars primarily through diet and exercise. I also use metformin which obviously contributes greatly, but I didn't have the same results on a different diet. What is this 'napoleon component' that has led to so much success? For me it has been Dr Richard Bernstein's low-carb diet.

This particular way of eating is a controversy in itself. Dr Bernstein mentioned on one of his telecasts that he had received a letter notifying him that his books had been banned by the ADA. The ADA, in the face of basic physiology, continues to recommend high carbohydrate diets to diabetics who have problems dealing with carbohydrates. They have only recently conceded that low-carb diets are acceptable for weight loss, but should not be followed long term. This stems somewhat from an understanding of the Atkins, high protein diet and the fear of kidney disease caused by the level of protein intake in the diet. Dr Bernstein's diet actually works out to roughly 20% of calories from protein and about 75% of calories from fat and the rest of the calories coming from slow-acting carbs (non-starchy vegetables). It would probably be considered more of a low-carb, moderate protein, high fat diet than anything else. This too is a controversy for the widely-accepted, conventional thinking that dietary fat makes you fat and gives you cardiovascular disease.

For both of the fears about kidney and cardiovascular disease, there is more and more evidence coming forth from the medical scientific community that insulin and insulin resistance and post-meal glucose spikes are the chief culprits in cardiovascular disease and microvascular damage. This means it is the carbohydrate in the diet, definitely not dietary fat and to a much lesser extent protein, that are the primary dietary factors which contribute to cardiovascular and kidney disease. There are plenty of other bloggers who have studied this to a greater extent and can articulate this much better than I have done, or can do. I've read a lot about the issues, but am generally not a hyperlink pack-rat, so you probably will have to google for the information on your own if you want to investigate my statements. Starting points could be material produced by Dr Michael Eades, Gary Taubes, Janet Ruhl, Dr Mary Eniq, Jimmy Moore, another female medical doctor whose name I can't recall, or a host of other low carb sites.

In the five months I've been following this way of eating, my sugars have maintained daily averages of mid 80s to 90s (mg/dL) with standard deviations between 7.5 and 9. This means that my actual readings have not fluctuated very far from my average reading. I test four to six times a day. Prior to that, on the ADA recommended diet, I was frequently spiking over 200 after breakfast and around 150 to 180 for the other meals--when I tested them. I usually was only testing twice a day before I changed.

With such a positive response in blood sugar levels and control, as well as fat-loss, and a resulting much lower circulating insulin levels, I am positively convinced that, in the absence of a cure, this is the healthiest way for me to manage diabetes. I don't see it as sugar-coated optimism, merely putting the best face on an otherwise horribly difficult and discouraging disease. I don't deny that all types of diabetes are a tremendous burden. However, managing diabetes with an appropriate low-carb diet freed me from the roller-coaster control I was having on a high carbohydrate diet, and reduces my risk of diabetic complications to that of a non-diabetic. Diabetes defines my meal, but not my health.

There are other reasons that are given for not adopting a low carb diet. There is a fear of low blood sugars. I don't take oral or injected hypoglycemic medications and have intact insulin regulatory and compensatory mechanisms, so I am fortunate in this matter. When blood sugar only rises a small amount, it only needs a small amount of insulin to correct, and there is less of a chance that it will produce harmful lows. I have seen that my hypos have pretty much disappeared on a low-carb diet.

Another big issue is being able to give up most carbohydrates. There are definitely physiological mechanisms that provide a dependence and even addiction to this class of macronutrients. It is not easy to give up those things, and I believe it takes a great deal of self-denial to successfully pull it off. This is a major factor in why many who consider the low-carb diet never try it, or give it up having tried it. Others have gone low carb, but not so strict so as not to feel deprived. As the beta cells recover from the glucotoxicity, they will be able to handle a bit more so glucose control can still be reasonable if carefully monitored.

Apparently there are also some unique physiological conditions that are worsened by going low-carb in the method of Dr Bernstein. It was my understanding that a MODY-type diabetes doesn't respond well to this type of diet. Also, since this ends up being a high fat diet, one person found that her body converted the extra fat to hormones that led to undesired results. I'm not informed enough to know if there are ways to circumvent these issues on a low-carb diet.

Clearly, the low-carb way of eating isn't for everyone, but it has reaped tremendous benefits for me so far. Longevity and perseverance is always a question that only time can answer; but as I said before, the results obtained are only positive and beneficial to my health.