is a valuable asset.
But your hope should be realistic.
Your best hope for controlling your diabetes is normalizing your blood sugars now.
That does not mean that the future will not bring great things.
Dia betes research progresses on a daily basis, and I hope as much as you do for a cure, but it's still on the horizon.
Researchers are currentlytrying to perfectmethods for replicating insulin-producing pancreatic betacells in the laboratory.
Doingthis in a fashion that's comparatively easyand cost-effective should not be an insurmountable task, and indeed the preliminary results are quite en couraging.
Once patients' cells are replicated, they canbe transplanted back into patientsto actually curetheir diabetes.
After suchtreatment, unless you were to have another autoimmune event that would de stroy these new beta cells, you would, at leastin theory, remain nondi abetic for the rest of your life.
If you had another autoimmune attack, you would simply have to receive more of your replicated cells.
An other very hopeful approach currendy undergoing clinical trials in humans is the transformation of the precursors of beta cells (the cells that line the ducts of the pancreas) into actualbeta cells without even removing them from your body.
This may be achieved by the simple intramuscular injection of a special protein and is now being tested for efficacy and possible adverse effects at three centers.
Another potential approach might be to insert the genes for insulin production into liveror kidney cells.
These arepotential opportunities for a cure, and have successfullycured diabetes in rats, but there are still obstacles to overcome.
Yet another approach to replacing lost beta cells has been used by two competingcompanies to curediabetes in animals.
The technique involves a series of ordinaryinjections of proteins that stimulate the remaining beta cells to replicate until the lost oneshave been replaced.
A very promising new approach relies on the fact that most diabet ics, even most type Is, have a few beta cells that still replicate.
Their immune systems, however, make white cells called killer T cells that destroy the new beta cells as fast as they are made , or faster.
If the culprit T cells can be isolated,they can be replicated and used to cre ate antibodies that canbe injectedinto diabetics to destroyalloftheir culprit T cells without impairing their overall immunity.
A diabetic's few remaining beta cells would then be able to replicate, eventually curing the diabetes.
It's possible that these new "former diabetics" would require antibody injections every few years to prevent the ap pearance of more culprit T cells.
Diabetes: TheBasics 51
With respect to the replication of beta cells, the catch for me and other diabetics who nolonger have any insulin-producing capacity is that the cells from which new beta cells would be repUcated ideally should beyour own, and after more than six decades I mayhave none.
Had my diabetes been diagnosed, say, a year earlier, or hadmy blood sugars been immaculately controlled immediately upondiagnosis, the injected insulin mighthave taken much of thestrain off my remaining beta cells and allowed them to survive.
Many people (including the parents of diabetic children) view hav ing to use insulin as a last straw, a final admission that they are (or their child is) a diabetic and seriously ill.
Therefore they will try any thingelse , including things thatwill burn out their remaining beta cells , before using insulin.Many peoplein our culture havethe no tion that you cannot be well if you are using medication.This is non sense, but some patients are so convinced thatthey must do thingsthe "natural" waythat I practically have to begthem to use insulin,which is as "natural" asone cango.
In reality, nothingcouldbe more natural.
Diabetics who still have beta cell function left may well be carrying their own cure around with them , provided they don't burn it out with high blood sugars and the refusal to use insulin.
Tests
BASELINE MEASURES OF YOUR DISEASE AND RISK PROFILE
T h e goal in the treatment program laid out in this book is to give you the tools and the knowledge to take control of your disease by normalizingblood sugars.My interest is not just in treating the symptoms of diabetes, but in preventing or reversing its consequences and preserving pancreatic beta cell function.
Essential to treatment is learning to monitor your own blood sugars.
Before you begin to monitor and then normalizeyour blood sugars, you should have a baseline analysis of your disease.
How much have your beta cells "burned out" in part from high blood sugars?
Haveyou already developed some easily measured long-term compUcations of diabetes?What are your risks for other diabetic compUcations?
Answering these questions willaid you and your doctor in learning the extent and the consequences of the disease.Your test results wiU also serve as valuable baseline data to which you will be able to com pare the effects of blood sugarnormalization.
Onceyour blood sugars havebeen normalized,such testscan be repeatedfrom time to time, to show what you're achieving.
Your improvements wiU give both you and your physicianongoing incentive for stickingto the program.
The remainder of this chapterdescribes a number of testsyour doc tor or his laboratory can perform in order to give both of you a picture of your diabetic condition.
I have laid these out notbecause it's neces sary for you to memorize them, research them, and know aU the ins and outs of them, but so that you can get the treatment you deserve.
Byoutlining these tests,I'm giving you a "shopping list"of tests I per form on myself and on my patients.
Generally, I recommend as many as you can afford or your insur ance or health maintenance organization (HMO) will pay for.
Com-
Tests: Baseline Measures 53
pleting more of the tests wiU addmore dimensions to the picture you gain ofyourdisease.
As some of these tests arecostly, anyor allmaybe skipped if you cannot afford them or if your insurance or HMOwon't pay for them.
It is your physician's obUgation to provide you with copies of aU your test results, whether from laboratory tests or from physical ex aminations.
This is your right; however, you must request them.
The laws governing medical records varystatebystate, and legislatures are Ustening to health care consumers and making changes regularly.
At this writing, however, it is most often the casethat medical records are the property of the doctor, so do not neglect to request copies of any results.
Such results can be potentially of great value when you visit another physician or speciaUst for treatment of anyproblems.
BLOOD AND URINE TESTS
Glycated Hemoglobin (HgbA,c) Glucose binds to hemoglobin (the pigment of red blood ceUs) when new red ceUs are manufactured.
Since the average red ceU survives about four months, the percentage of hemoglobinmoleculesthat con tain glucose (HgbAlc) provides an estimate of average blood sugar over this time frame.
One of the benefits ofthis test is that it givesyour physician an index by which to test the accuracy of your own blood glucoseself-monitoring results.If your measurements are stricdy nor mal but your HgbAlc is elevated, then your doctor has a clue that something is awry.
There are, however, a couple of significant drawbacks to this test.
First is that the test is only a measure of average blood sugars.Second, elevatedblood sugars may take 24 hours to have any long-term effect on HgbAlc, andifblood sugar iselevated for only partofeach day and is normalized or too lowthe restof the time,your HgbA,c results may appear deceptivelylow.
Thus, if your blood sugars are only elevated for a few hours after meals, your HgbAlc may not be affected, but many tissuesand organs throughout your body will be injured.
The other drawback is that the upper and lower ranges of"normal" values reported by most labs are usually erroneously high and low, re spectively.
In other words, the ranges are usually much too wide.
Thus, it's up to your physicianto decide, basedupon his experience, what the proper normal range for his lab should be.
Some doctors have their
54 BeforeYou Start
own formulas for estimating average four-month blood sugar levels from HgbAlc.
Anormal value should correspond to blood sugars of about 80-95 mg/dl.
The experience I've had with the lab I use (the largest in the United States) for my patients is that a truly normal HgbAlc ranges from 4.2 percent to 4.6 percent, which corresponds to blood sugars of about 83-90 mg/dl.Mine is consistently4.5 percent.
A recent study of "nondiabetics"showed a 28 percent increase in mor- taUty for every 1percent increase in HgbAlc above 4.9 percent.
Because the blood contains more recentlymade red cellsthan older ones, recent blood sugars have more of an effect on HgbAlc than do earUer blood sugars.
The test value therefore levels off after about three months.
Any ailment that hastens red blood ceU loss will cause a deceptive shortening of thetime frame reflected bytheHgbAlc.
Such ailments include Uver and kidney disease, blood loss, hemoglo binopathies, et cetera.
High doses of vitamins C and E can cause a de ceptivelowering.
Serum C-Peptide (Fasting) C-peptide is a protein produced by the beta cells of the pancreas whenever insulin is made.
The level of C-peptide in the blood is a crude index of the amount of insulin you're producing.
The level is usuaUy zero in type 1 diabetics, and within or above the "normal range" in mildtype 2 obese (insulin-resistant) diabetics.
If your blood serum C-peptide is elevated, this would suggest to your physician that your blood sugar maybe controllable merely by diet, weightloss,and exercise.
If, at the other extreme, your C-peptide is below the limits of measurabiUty, you probably require injected insulin for blood sugar normalization.
C-peptidemeasurements, to be most significant, should be checked aftera 12-hourfast whenbloodsugars arenormal.The test can be best interpreted if blood sugar is measured at the same time, because in nondiabetics high blood sugars cause more insulin (and C-peptide) production than do lowblood sugars.
This test,while of interest, is not absolutely necessary.
Complete Blood Count (CBC) Part of most medical workups, this isa routine diagnostic test that can disclose the presence of ailments other than diabetes.A CBC measures the number of various typesof ceUs found in your blood , white cells, red ceUs, and platelets. A high level of white blood cells, for example, can disclose the presence of infection, while too few red blood cells
Tests: BaselineMeasures 55
can indicate iron deficiency anemia. Many diabetics have inherited thyroid dysfunction, which can cause low-normal to low white ceU counts. Awhite ceU countless than5.6 suggests that a full thyroid pro file should be performed. This must include free and total T3 and T4.* ACBC can alsodetectcertainhematologic maUgnancies, whichare usually moreeffectively treated the earner they arediscovered.
Standard Blood Chemistry Profile This battery of twelve to twenty tests is part of most routine medical examinations. It includes gaugesfor such important chemical indica tors of health as Uver enzymes, blood ureanitrogen(BUN), creatinine, alkaline phosphatase, calcium, and others. Ifyouhave a history of hy pertension, your doctor maywant to add red blood ceU magnesiumto this profile.