Tuesday, February 8, 2011

Why Worry if You Feel Great?

I jotted this title down months ago, in a little detective note pad I carry around everywhere, I know, a little geeky, but what can I say.

I was reminiscing about the early days of diabetes, well early is subjective, but for me it was when you were given one shot a day and they measured control with urine dip sticks and your ability to gain weight.  Scary, but I survived, and so did many others. Imagine dipsticks for control, crazy!
"Those were the days"

I didn't feel all that bad on one shot a day, and actually started to feel worse when my control tightened and was consistently near normal range.  The body is amazing, it got used to the high levels, and that was that, it equalized, so to speak. 

When the levels normalized, the body said "What the hell is going on!" and sent the signal to produce the good old epinephrine (fight or flight Response) and wham, you start feeling like crap with your good numbers. 

For some, including me, it  was discouraging not knowing that the feeling would subside in time.  Why torture my self, why shoot for normal levels when I feel shaky, and low all the time. That's where knowledge is power, and motivating!  It took one Diabetic Educator in 1990 to say, "you know it is only temporary, and then you will feel great!"  One moment, one snippet, is all it took! 

I get the above scenario a lot from patients and those with higher A1C's.  They say " I feel fine, why should I change anything" or "Well,  I took the night time insulin and my fasting is 5 mmol,  but boy I feel like crap" or they claim, that their normal is actually 10mmol (multiply by 18 for U.S.) The point is, they don't feel the need to change if they feel good. Of course I jump at the opportunity to share my snippet, in hopes to motivate them to keep there levels down just long enough to feel fab! 

Most folks have never been told the reason behind feeling worse with better numbers.  I am fortunate to be in a position to explain these pearls of experience with folks trying to better manage their diabetes control.  I hope anyone going through diabetes and feeling "great" and not worrying will take the snippet for themselves or a loved one, and shoot for those normal targets!

I did find one research article written by Gill Spyer and colleagues titled,  "Hypoglycemic counter-regulation at normal blood glucose concentrations in patients with well controlled type-2 diabetes."  They took 7 type 2 diabetics with a mean A1C of 7.4%, and tightened their control.  This is what they found:

"Symptom response took place at higher whole-blood glucose concentrations in diabetic patients than in controls"  and they also commented "This effect might protect type-2 diabetic patients against episodes of profound hypoglycemia and make the achievement of normoglycaemia more challenging in clinical practice."
Most of my experiecne is purely anecdotal.  But this study certainly supports the theory.

Have you ever Been High for a period and dropped low?
If so please share your comments. 


G Spyer MRCP, Prof A T Hattersley FRCP, K M MacLeod MD, (2000) Hypoglycaemic counter-regulation at normal blood glucose concentrations in patients with well controlled type-2 diabetes,
Lancet. 356(9246):1970-1974.


Amy said...

"(multiply by 18 for U.S.)" Geesh . . . thank you!!!! I have been reading these wonky numbers on various blogs and knew they were bs readings by a different measuring system, but had NO CLUE how to equate it to what I know. Now I do!

Interesting stuff on the feeling attached to numbers and then getting used to it that way. I equate it to wearing perfume. At first you only need a drop because the smell is foreign to you. As time goes on, you become used to the smell and end up putting more and more perfume on.

Or. maybe that is a really bad analogy. You know; you being a guy and probably not wearing perfume and all.

How about this: Great post!

Reyna said...

Isn't it all relative? If one is running "high" all the time...normal values make them feel low. It is the same thing with too tight of control and hypoglycemic unawareness in some I thought. The hypo-feeling can be related to a relative drop even though the actual number is not low.

Great post Trev.

And at Amy, if Trev is wearing perfume I am outta here! LOL and totally J/K.

Valerie said...

Hi there! YES, I've been experiencing this lately. My a1c used to be around 6.5% but over the last year or two, it has climbed higher. I've noticed that my body has gotten used to the higher numbers and has made me more sensitive to the "lower" numbers.

Jonah said...

I was diagnosed with an A1c of over 16% and anything below 100 felt low- my first, extremely symptomatic low in the hospital was with a blood sugar of 88 (4.9 mmol).
Over the following five months my blood sugar dropped to the point where I couldn't feel it when I was in the 20s (below 1.5 mmol). I was terrified, certain that the trend would continue and that I was about to die of a low I wouldn't feel! For who knows what reason, it got better.

I think there's evidence that supports lowering blood sugar more gradually. It is known that a sudden drop in A1c is associated with complications right after that drop. It really does stress the body.

You could have, theoretically, gotten control somewhat more gradually with probably comparable long term effects without feeling so shitty.

Because somebody who feels like crap at a 5 mmol probably actually hasn't been spending enough time at 9 mmol.

Trev said...

No worries, no perfume for this chap, well there was that one time....kidding. Cheers, and thanks for the comments.