This remission dataset

documents - and provided the means of - my losing 100 pounds of fat and rendering myself, according to my doctor, "no longer diabetic" within a year of diagnosis of type 2 diabetes. Despite my doctor's use of the word at the time, I don't claim to have "cured" myself. By this expert consensus definition, I achieved remission, having reached and sustained normal levels of blood glucose (blood sugar).

Type 2 diabetics who can achieve remission, or normoglycemia (euglycemia), are as close to a cure as is possible for a disorder characterized as chronic (no cure) and progressive (only gets worse). Remission can vastly improve quality of life and can forestall T2D's usual progression through comorbidities toward premature death.

Day-to-day data are self-reported. Medical outcomes are documented by Kaiser-Permanente.
Showing posts with label comorbidities. Show all posts
Showing posts with label comorbidities. Show all posts

the poker face of depression

As part of the promotional apparatus for Batman v. Superman: Dawn of Justice.,Yahoo Movies interviewed Ben Affleck and Henry Cavill. Interviewer Tom Butler asked Cavill and Affleck to respond to the critics' "mixed response" to the film. Cavill gives a stock Hollywood reply: Critics don't matter, what matters is box office. (Cavill actually tries to state his criticism of critics more diplomatically, though his attempt totally misrepresents the nature and value of professional criticism. Of course, he uses "audience" as a euphemism for box office.) Affleck, prompted by Butler, simply says "I agree" (with Cavill).

Enter YouTube producer Sabconth, who inserts a montage/barrage of critically damning quotes, fades out Cavill's audio, digitally pans and zooms in to Affleck, and replaces the substance of Cavill's response with the first verse of Simon and Garfunkel's "The Sounds of Silence." Sabconth's text montage conceals Affleck's grin and laugh in reaction to the phrase "mixed response," and cuts before the small smile he gives after his brief answer. (Presumably incidentally, the manipulated clip suggests Cavill is a blathering fool; wrong-headed and/or deceptive as his response may be, it's not foolish. The man is doing his job.) That clip, under the title "Batman V Superman - Sad Affleck," goes viral.

Along with some 14 million others, I Laughed Out Loud. And as soon as the clip ended, I Googled "Ben Affleck depression." Sure enough, Affleck's celebrity and recent divorce bubbled up: both "depression" over the divorce, and Depression as a cause of it. (This just in: Depressed people can be hard to live with.) I can't offer a diagnosis I'm not qualified to make of a person I've never met. I can look at a clip of an actor's unscripted reaction and hear my gut say: I recognize that face, and it resonates with what I know about myself as a chronic anxious depressive.

The Internet thought otherwise. "Sad Affleck" became a fixed phrase. Variety's Lamarco McClendon elaborated, taking Affleck to task for his downward gaze and describing him as "distraught" and "sullen," as well as "saddened." McClendon's piece begins with a taunt that Batman (Affleck) can't "hold his composure in the face of adversity," (Many of us might say that composure is exactly what Affleck held; clearly we do not work in Hollywood.) Michael Cavna's reading in The Washington Post is more sympathetic: "Affleck...looks vulnerable concerning his new superhero turn as the Dark Knight, and the mind behind those hurt eyes seems to wander..."

So which is it? Sadness, downcastness, distraction, sullenness, discomposure, vulnerability, hurt, a wandering mind? Yes. Welcome to depression, friends, that ever handy Wet Blanket that throws itself over our material and emotional turmoil, and life's disappointments and fears, and keeps our heads from exploding at the shocks others seem to be able to ride out with "composure."

As diabetics, we are prone to depression. Depressives are prone to diabetes. As with insulin resistance and the accretion of body fat, I find the chicken-and-egg question less valuable than recognizing a vicious cycle that requires intervention to break. As with most mind-body dynamics, there are few cleanly reciprocal dyads. Research notes the correspondence of risk factors for diabetes with those for chronic pain and depression, including poverty, low social status, susceptibility to discrimination, past injuries, physical inactivity, lower self-confidence or self-esteem, and a lack of social support.

Ben Affleck would seem to be exempt from many of these risk factors: Both his present life and his past include many elements of privilege; they also include an alcoholic (since rehabilitated) father who apparently stumbled through a series of working-class jobs, and whom he "lost"—since reconciled—at age 11. I'm sure many people would find my own responses to chronic depression inappropriate, pathetic, ludicrous. (We may find out with a forthcoming personal tour of my depression, to be published with further information on depression and diabetes research.) While sometimes the temptation to laugh at or feel superior to celebrities—or me—may be too much to resist, I hope these observations might spark a bit more empathy and a bit less judgment toward depressed people in your life—including, as needed, yourself.

Graphic sourced from Living with Invisible Illness.

what they don't say (enough)

Distortions and omissions in the diabetes discourse are a recurring theme here - usually how:
My top-of-mind short list for the biggest diabetes information gaps* includes: 
In short, diabetes usually cannot be resolved by, as one pharmaceutical company shamelessly touts, "simple changes."

Of course, those of us with type 2 diabetes have it "easy." Those with type 1 can match all of the above point for point (with some variation) besides being burdened with:
  • fewer treatment options 
  • a more painstaking, invasive, and wearying—and typically decades longer—self-care routine
  • immediate and potentially mortal risks that can come from monitoring and treatment errors
Cheery thoughts for a sunny winter's day! Well, they asked.*

Good heath and good luck,
M.


* This theme was suggested by an online survey for people affected by diabetes to gather "missing" information—"gaps" in what we hear and read—to incorporate into educational videos. WEGO Health, a platform for online health activists, made donations to diabetes organizations as part of their survey promotion. I didn't know much about the sponsors at the time, but thought they were asking the right questions. Edited from the original post: 2012-02-03.

normal? really?

Here's a secret. When it comes to blood glucose levels, nobody knows what "normal" means.

As noted before, medical research finds increased incidence and risk of diabetic comorbidities or "complications" (late-stage symptoms) correlating with blood sugar levels currently deemed "pre-diabetic" or even normal.

We know this more precisely now, yet it's nothing new. The correlation of elevated blood glucose with morbidity and mortality is long-established; it informs our current definition of normal as fasting blood glucose under 100 mg/dL, although in an entirely inadequate way.

As long ago as 1980, impaired glucose tolerance (defined as blood sugar levels of 96 mg/dL or greater after a clinically-administered "challenge" of 50 g oral glucose), roughly doubled risk of death due to coronary heart disease.

In short, that level of post-challenge glucose intolerance, several points within today's "normal" fasting range, kills people. Quibbling over the additional 25 mg/dL that distinguish the "pre-diabetic" from the diabetic seems as useful as speculating over how many angels can dance on the head of a pin.


p.s. I was recently surprised to find an untapped prescription for glucose test strips, and was able to get it extended. I'm gathering new data on my own progress and setbacks, and should be able to publish them soon. I shall also finally incorporate into the data the standards for normoglycemia that have been tightened - obviously to my mind not enough - since my original intervention in 2003.

eye risk before diagnosis

A recent study proposes new thresholds for predicting risk of diabetic retinopathy. Using more precise gradation in the "good control" or "prediabetic" range than comparable earlier research, Massin et al. found the following correlations among 700 French volunteers studied for ten years, and were confident in proposing them as predictive:
HbA1c %fasting plasma glucose mg/dLpredicted retinopathy
6.06.0%
1088.4%
11614.0%
6.514.8%
The takeaway? A difference in the range of half a percentage point of HbA1c, or 8 mg/dL of fasting plasma glucose, roughly doubles one's risk of potentially blinding retinopathy, from about one in 15 to one in 7. This risk correlation held even among subjects who did not develop diabetes, as currently defined, over the course of the study, retaining their diagnosis of "impaired fasting glucose".
The current diagnostic threshold for diabetes is an HbA1c of 6.5, the highest value in the proposed predictive model. Since the diagnostic threshold in terms of fasting blood glucose is 126 mg/dL, the remaining values are well below the threshold, in the so-called "prediabetic" range. Normoglycemic, neither diabetic nor prediabetic, is currently defined (at the upper end) as under 100 mg/dL fasting glucose or under 5.7% HbA1c.
I have two reasons for highlighting this study:
  • Absent a risk of going hypoglycemic—into dangerously low blood glucose levels—there is a compelling argument for driving blood glucose levels down even if you are being told, as people in the "prediabetic" range often are, that they have "good control". A level of control that may double my risk of blindness doesn't seem to me to have much good about it. (Type 1 diabetics or others considered to be at higher risk for "going hypo" may want to check with their care team about the extent to which tight control might mitigate both short- and long-term risks.)
  • If diabetes is a progressive, degenerative, debilitating, and potentially fatal disease with multiple comorbidities—it is—and if "prediabetes" is an independent mortality risk whose defining numbers successfully predict so-called "complications", or more precisely late-stage symptoms, of diabetes—it is and they do—why on Earth is the diabetic establishment still sugar-coating the reality of this disease by mucking around with terms like "prediabetes"? When will medicine catch up with science and lower the diagnostic threshold? It has done so before, and can do so again. Come the day!
source: Massin P et al. Archives of Ophthalmology, 2011: 129(2): 188-195