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Roger Costello
TryHard
WA
UZZ31 V8 Limited

Posts: 258
Reg: 07-2005

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Thursday, May 04, 2006 - 06:23 am, by:  Roger Costello (Roger) Edit Post Delete Post Print Post   View Post/Check IP (Moderator/Admin Only) Move Post (Moderator/Admin Only)

The following is not intended as a guide to treatment, it is my story of how I addressed my issues. It is intended to stimulate thought, discussion and individual research, not as a template for your own treatment. You should make all decisions on how you approach diabetes, sleep apnea or any other medical conditions in conjunction with your own appropriately qualified medical practitioner or specialists. The views expressed here are my own and not in any way endorsed by Soarer Central, Peter Nitschke or the moderators of the forum. This is not medical advice; it is just my experiences - your mileage may differ.

More than a decade ago out of curiosity I purchased a blood glucose-testing unit. I had at my doctors insistence over many years prior had glucose tolerance tests and pissed on innumerable plastic sticks and in bottles but the result consistently showed nothing was amiss. As I was and still am obese (120+ kg) and my father and his father had type II diabetes it was a reasonable concern.

I don't drink or smoke and yet I was not convinced all was well. My skin had always felt a bit sweaty even straight after a shower and I did not enjoy strenuous exercise as it left me feeling revolting. Out of curiosity I started taking my blood sugar readings at different times of the day and they were always between 4 and 6 depending on what I had eaten.

One night I ate 2 crumpets with butter at about 11 pm and by chance took a blood sugar reading half an hour later. My blood sugar was about 11. I was dumbfounded and not a little concerned. I then had some blood tests for glycated haemoglobin or HbA1c, which give a 2 to 3 month picture of blood sugar control. The results showed that all was not well and I started testing blood sugar more regularly. I found that during the day I was fine but at night especially if I ate later in the evening my blood sugar was going up above 10.

I did a lot of reading and researched as much as I could. The major concern I had was that this is described as a progressive disease and I had no desire to see it progress. I also had very little faith in the knowledge and ability of the average medical practitioner to stay on top of all the relevant research findings and management practices in this area.

Some things became clear to me.

First this condition was most likely genetic in origin given the familial history.

Second I was probably insulin resistant from a very young age. I had alway been puzzled when reading about people’s experiences with the insulin hit from eating ice-cream. It had never affected me in this way.

Third it was serious, I had had a work colleague in his twenties die from type one diabetes complications and nearly been killed when a 17 year old friend who had not told me he was diabetic passed out while driving.

My conclusion was that like the majority of people with what was then described as syndrome "x" I was probably insulin resistant. I had a lot of tests done as I had a theory it could be related to a deficiency in human growth hormone. I was always tired and felt worse when I woke up in the morning than when I went to sleep.

After a fully Borg'd up ($1,000) overnight sleep study I was told I had sleep apnea and required CPAP treatment. I knew the chief design engineer at Resmed and got him to send over one of their prototype automatic pressure adjusting (titrating) CPAP machines and had another sleep study (another $1,000). That fixed the sleep apnea problem. About 8-12 % of the population suffer from sleep apnea. It is not a symptom or cause of diabetes but exacerbates its effects. (My low human growth hormone theory was sort of correct, it was too low but that was a side effect of the sleep apnea rather than the cause of my problems)

I was now not tired all the time and feeling a lot better. My blood sugar at night did not improve and my skin still felt sweaty. Insulin resistance means that your own cells are not able to efficiently use the insulin produced by your pancreas to convert blood sugar pumped out by you liver into energy. The pancreas has to make a lot more insulin than would normally be required to process that sugar. Eventually the continual requirement to pump out much more insulin than normal starts to damage the cells in the pancreas that perform this function. The islets of Langerhans as they are called wear out.

Up to this point the average person is probably unaware that anything is amiss. To use a Soarer analogy, if you have the cruise control on and one of your never serviced and slightly sticking brake callipers starts to drag on a long trip the cruise control will just open the throttle a bit to compensate. As the rotor gets red hot and the fluid boils you may wonder why it pulls a bit to one side but the brake drag will decrease before you get too concerned as the pads and rotor self destruct. A Kangaroo jumps out in front and you hit the picks hard. At this point only one front brake works at all and the ABS goes berserk. You stop the car and notice the red hot rotor, the horrible stink and realise all is not well.

The problem at the point we discover our blood sugar is too high is that quite a bit of damage has already been done. Insulin at high levels over a long period damages the circulatory system and does unkind things to other parts of the body. The pancreas may have lost most of its ability to produce insulin and the remaining islets are not in good condition.

Many GP's in this scenario will prescribe a drug to stimulate production of additional insulin. This will keep the blood sugar under control for a while but after a year or two the pancreas gives up as the last islets flame out and you will need oral or injectable insulin for the rest of your life.

You may also be given a regimen of exercise and altered diet to assist in managing you condition. Exercise and an appropriate diet is helpful through reducing the amount of fat you are carrying as that assists in lowering insulin resistance, easing pressure in those islets a bit. Your general fitness can improve as well.

Other drugs may be offered including Metformin and if you are fortunate Avandia.

Metformin (Diabex, Diaformin) is one of the oldest treatments available. Its method of action is only partly understood. People with type II diabetes livers turn food into blood sugar (gluconeogenesis) about three times quicker than a normal non-diabetic individual. This is not good because your pancreas has to produce insulin much faster to try and reduce that blood sugar. Metformin slows down or moderates that process and also improves you body's cells ability to use insulin efficiently i.e. lowers insulin resistance. It was originally derived from the French lilac, which has been used for several hundred years to treat the symptoms of diabetes. It has only been used as a drug since the late seventies.

Google will give you lot's of information on Metformin. Its major side effect for me was that I had to take three 850 mg tablets a day and this left me feeling permanently queasy. It needs to be started off at a low dose and gradually increased to avoid diarrhoea, cramps, nausea and vomiting. It can add as much as 10 healthy years to your life so it is worth thinking about. It should also be taken with or after food to reduce the side effects and that is not always convenient.

There has been a recent development with Metformin, which has greatly improved things. It is now available in a slow release form with two different binders that stretch out its absorption in your gut from almost immediate to around 18 hours. The initial release is delayed by about four hours, for me this is wonderful, it means it is absorbed not in my stomach making me feel permanently “off” but lower down in the plumbing. I now take two 500 mg tablets in the morning and two in the evening and get the same benefits without the nausea I have suffered from for a decade.

Metformin improved my blood sugar considerably but it was still worsening as a trend over time. I started to get small pimple like boils on my upper legs and had problems with fungal infections of my toes and feet, both classic side effects of blood sugar being too high.

I earlier mentioned Avandia (rosiglitazone maleate), which I decided was the best available drug on the planet for increasing insulin sensitivity. There were two problems, it was not available in Australia and it cost the equivalent of $280 for a 28-day supply. I asked the American manufacturer if they would consider importing it and they obliged with a single batch as a marketing experiment. They obtained the necessary approvals to sell it and I still remember going to my long suffering GP for the first prescription. I had to spell it for him as it was not in any of the MIM’s or drug references then available to a GP and he had never heard of it. I gave him all the studies and literature I had available and he was keen to try it out.

The pharmacy had to special order it as it was not in their supplier’s system and when it finally arrived marked batch 0001 I was as excited as when my Blitz Access ECU arrived at the front door. It was amazing; my blood sugar went down and stayed down. I felt totally different, my skin felt different and for the first time in my life when I had an ice cream I felt the insulin “hit”. Over a few months my metabolism learnt to regulate insulin better and the initial "what the hell is happening" feeling from that first Avandia ice cream experience became a more normal relaxed post Baskin Robbins type glow. The cost was around $20 a day as I was also paying for my father’s prescriptions. He also benefited from the combination of Metformin and Avandia. He initially had a blood sugar reading between 17 and 19 and this went down to around 9 which was considered an excellent result by his doctors.

I lobbied for Avandia to be made available via the PBS and after many years and many others efforts they finally added it to the list of subsidised drugs. It still requires an authority from the Commonwealth to prescribe along with blood test results demonstrating the need and efficacy for the individual patient. I think for a long time we were the only two people in WA using it as it was almost unknown and considered unaffordable to prescribe. It is more common now but still very much under-utilised in my view.

One really good thing about Avandia combined with Metformin is that over time it actually allows you pancreas to partially recover some of its lost ability to produce insulin. The missing islets will not re-grow but the ones that are just about cactus can become functional again. The irony of the islets is that they are damaged by having too much insulin in the blood, so the harder they work the quicker they are stuffed. In my view this is one of the main causes of the progression of type II diabetes. Unless you somehow can make your body more efficient at using its own insulin, hence reducing it's required concentration in your blood, you end up losing the ability to make it at all.

Eventually even with Avandia and Metformin my father wanted to get his blood sugar down into the normal range of 5 to 6 and this was just not happening. His GP tried adding sulfonylurea to the regimen but the improvement was minimal. My father had prostate and kidney cancer and elevated blood sugar can hasten the growth of these types of tumors. I studied many different approaches and finally found a very new set of patents taken out by the American USDA (which is very unusual in itself) on several compounds isolated from cinnamon. In test tube assays, the compounds, called polyphenolic polymers, increased sugar metabolism in fat cells twenty fold. The amount of cinnamon required to achieve a significant clinical effect amounted to around one gram a day. My father started adding this to his porridge in the morning and his blood sugar went from 9 to 5 overnight. I have also experienced significant benefits from adding a small amount of cinnamon to my diet.

One interesting epidemiological study attempted to find why there had been such an explosion in type II diabetes in America after a long period following the Second World War with little growth in the number of new cases. One factor in diet turned out to be significant. Many people apparently regularly consumed cinnamon donuts for some decades during and after the war as an accompaniment to coffee. This practice diminished at the same rate as type II diabetes cases increased. It was conjectured that the prophylactic effect of the cinnamon on the donuts was the major factor involved.

There is no list at the end of this setting out a magic formula. You need to do your own research on these options and make your own choices. For me, my blood sugar is stable between 5 and 6 and I am not exactly a role model for diet and exercise to help control type II diabetes. I would be fitter if I exercised more and thinner if I ate less. The only definite advice I would give is that anyone overweight or over 40 should discuss with their doctor taking a statin such as Lipitor (atorvastatin) and 100 mg of aspirin preferably in an enteric coated form each day. Both can considerably reduce the risks of heart attacks and strokes. I have had too many friends drop dead in their early forties who were fit and active. Fitness and health are different just as flash paint-jobs and body kits do not mean that a Soarer is in great mechanical condition.

If you have read this far congratulations. I am happy to try and answer queries but I can only talk about my experiences. This is primarily a forum about Soarers and Celsiors (the WA section excluded). Keeping the drivers in good condition is important, but don't forget while we don't need to be qualified to make decisions about car maintenance the person prescribing our medication has to be a doctor.

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