“Those who cannot remember the past are doomed to repeat it.”
-George Santayana, Life of Reason, Vol 1, Reason in Common Sense
Understanding where we are and where we’ve been helps us understand where we are going. We use three blood tests to help people understand their past, present, and future as it relates to blood sugar disorders like diabetes.
The three tests are Hgb A1c, glucose, and insulin.
Hgb A1c: This is a test that measures the average blood sugar over the last three months. It takes into account everything you’ve eaten, done, or experienced during that time that might alter your blood glucose. It often runs higher than people expect but it helps take into account the effect of food on the body. Diabetes can be diagnosed when this number gets to 6.5%. Healthy values would be less than 5.5% or even lower.
Glucose: This is a measure of the amount of glucose floating around in the blood stream at any point in time. It is simply a snap shot of what is going on. Typically this is done fasting so as to assess the ability of your body to get back to normal when we stop letting our food choices get in the way. Generally a level above 100 mg/dL is too high. When it gets above 125 mg/dL we call that diabetes. A non-fasting glucose show you how your body may be reacting to a high sugar meal too. A non fasting glucose above 150ish ought to give you pause and make you rethink what you had to eat.
Insulin: This a measure of the work the pancreas is doing to get your blood glucose to its current level. It helps us understand whether that job is easy or hard. For instance if you have a normal blood glucose but a very high insulin level that means your pancreas is working extremely hard to maintain that normal glucose. Your pancreas can’t do that forever and will wear out sooner than you might want. When the pancreas fails the blood sugar starts to rise. It is estimated that by the time your blood glucose rises above 100 mg/dL one half of your pancreas has already died off. A high insulin level is a strong indicator that change needs to happen to prevent the damage of diabetes.
So if you want to know the past, present, and future of your body’s blood sugar come in and talk to us about these three tests.
Ever thought about the fact that some people always assume that other people who are overweight are worse off than someone who isn’t? Have you ever thought that yourself?
I hear from patients all day long about how they feel okay about their health even when they have an awful diet and no exercise habit. Most of the time they feel this way because they aren’t overweight or at least aren’t as overweight as someone else in their life.
Society judges health based primarily on weight. It’s just not that simple.
I’ve come to believe that obesity is a luxury. It’s one extra (and very powerful) mechanism the body has to protect us from the outcomes of a less than perfect nutrition plan. Sometimes those choices are voluntary and sometimes they aren’t.
Think about it this way. A simple 7 inch banana has enough sugar (ie, glucose) stored within it in various carbohydrate forms to raise my fasting blood sugar from 85 mg/dL all they way up to 351 mg/dL. If my body didn’t protect me, then a simple banana would make me instantly diabetic.
Thankfully my body is better at protecting me than sometimes I am at choosing my food. All that sugar is moved from my blood stream into my cells. My brain uses some to do math and write a sentence. My heart and lungs use some to beat and breathe. My muscles use some to walk down the sidewalk or ride a bike. In the end, almost after all other cells have used as much of that sugar as they can, the body must still get rid of the rest of it. If it doesn’t, bad things like blindness, Alzheimer’s, and kidney failure can occur. So where does that sugar go?
That’s were adipose (the five dollar word for fat or storage cells) comes into play. Adipose takes up the extra sugar and stores it. As that happens these cells grow larger. So they really are a protective mechanism for keeping too much damaging sugar out of the blood stream. But not everyone has adipose cells that are good at taking up the extra sugar. Some people lack virtually any ability to grow their adipose cells in response to a bad diet. Nearly 20% of diabetics have a normal weight.
So why is obesity a luxury? When you need protection from less than ideal food choices it’s nice to have that extra place to store your bad decisions. The alternative is to let loose all those extra sugars into the blood stream and allow them to cause havoc on your system.
We tend to consider cars with more airbags and safety features as better vehicles. We should be thankful we get our own safety features for our bodies. Better yet though, let’s not live a life dependent on our safety features protecting us from the consequences of our choices. Let’s eat and exercise in such a way as to not stress, strain, and overwhelm our body’s plan to be healthy and strong.More
The Syndrome That’s Sweeping the Nation
One of the most common and damaging diagnoses I see day in and day out is one whose name many of my readers have heard little about. It is a syndrome that is epidemic in the U.S. with a staggering 1/3 of adults meeting its diagnostic criteria. It parallels the rapid increase in overweight and obesity in the U.S. (with 2/3 of adults now falling in these categories). With obesity occurring in children and adolescents at three times the rate that was present in the 1960’s, this syndrome is also becoming more prevalent in these younger ages as well.
One “catches” the syndrome by lack of exercise, having a poor diet (especially one high in simple carbohydrates – sugars and starches), and putting on belly fat. Hours logged in front of the TV, computer, or video games sipping sweet drinks or beer and munching on carbs puts us on the fast lane to developing this malady. The condition we’re talking about is called metabolic syndrome.
Metabolic syndrome arises from insulin resistance in the body and increased fat deposition. Over time, as we fall into a lifestyle that has little regular exercise and lots of starchy or sugary meals, the insulin produced by our pancreas has less and less effect in the body. Eventually our blood sugar starts to rise, despite there being plenty of insulin circulating.
This situation has numerous negative effects on the body. That’s why metabolic syndrome is a risk factor for heart disease, stroke, diabetes, fatty liver, sleep apnea, and several cancers, including colon, kidney and breast. There is even some evidence that it accelerates cognitive (brain function) aging and deterioration.
How is this syndrome diagnosed – how do I know if I have it? The diagnosis is based on having at least 3 of the following 5 characteristics:
- Fasting glucose ≥100 mg/dL (or on meds for diabetes or high blood sugar)
- Blood pressure ≥130/85 mm Hg (or on meds for high blood pressure)
- Triglycerides ≥150 mg/dL (or on meds for high triglycerides)
- HDL-C (“good cholesterol”) < 40 mg/dL in men or < 50 mg/dL in women (or on meds)
- Waist circumference ≥40 inches in men or ≥35 inches in women; if Asian American, ≥ 35 inches in men or ≥ 32 inches in women
Yes, metabolic syndrome can be treated with numerous medications that help reduce blood sugar, lower triglycerides and control high blood pressure. But that’s not the first way to go about this. The real core of treatment involves turning around the habits that got us there in the first place. A healthy low carb diet and a 30 minute brisk (3 to 4 mile per hour pace) walk 5-6 times per week (or the equivalent on a stationary bike, elliptical, swimming, etc.) producing a slow weight loss can typically cure, or greatly improve this syndrome. Of course the challenge is actually doing this and sticking with it. Finding a group or partner to do it with is hugely helpful here. And the health rewards are enormous as you begin to feel better, get your energy back, and minimize the long list of complications of metabolic syndrome.
Beyond the daunting personal impact of metabolic syndrome is the fact that if we try to treat it only with medicines, or if we just wait for all of its complications to show up and then treat them, it will absolutely overwhelm the health system in our country. So if you caught this syndrome, or see yourself heading that way, find a partner and start working on the self-cure. You may or may not need a little help from a medicine, but your efforts are the cornerstone of the cure. So don’t be trendy on this one; make the effort to help this popular syndrome pass you by.
Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. Contact him at 982-0835