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Every Month: a Review of Major Teaching Points

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A Power Program for Student Review

Course Coverage 2016

  • Jan Fit To Last
  • Feb Urbanized Eating
  • Mar Mind & Memory
  • April Special Senses
  • May Metabolic Syndromes
  • June Sugar Diabetes
  • July Diabetes Complications
  • Aug Aging
  • Sept Atheroma
  • Oct Longevity
  • Nov Cancer
  • Dec Predicaments
Begin Countdown

Last month’s Energetic Longevity angle was: Diabetic Complications…high blood sugars promote aging, including wrinkling, and provide material for the review of this Countdown.

Although the blood sugar is a dominant clinical feature in the diagnosis and management of diabetes, it has become too constrained a view of the metabolic disorder. Its failed insulin effect involves delays in much metabolic chemistry, and a slowing of all nutrient deliveries. The clinical focus on glucose has roots in the disease history (diabetes has been recognized from Greek antiquity) and on the classic clinical complaints of fatigue, thirst and urination…that gave diabetes mellitus its (translated) name of: an excessive pissing of sweet-tasting urine.

Decades into the insulin era, physicians continued to regard good diabetes care to be strategies that kept sugar out of the urine while avoiding hypoglycemia. That was become too limited a view, as research eventually showed. Blood sugars above 100 mg% link up with tissue proteins and do damage that effects arteries, eyes, nerves and kidneys. The damaging process is called glycation, a sugar-protein linkage that good modern care tries to minimize with close glucose control.

When elevated, blood glucose molecules form distorting sugar-protein complexes with selected tissues. Called glycoproteins, such complexes slowly degrade any affected tissue’s body function. Cellular organization is distorted. Organ performance is gradually compromised. Depending on the tissue, it leads to blindness, loss of a limb, heart attacks, strokes or kidney failure.

In the eye, glycoprotein complexes form in retinal capillaries and produce ‘dot and blot’ bleeding sites…with tiny cloud-like puffs of serum exudate. They come and go, but eventually interfere with vision, so that in the US, diabetes is now the most common cause of new cases of legal blindness.

In the kidney, microscopic filtration systems (called renal glomeruli) become   damaged by glycation. They begin to leak plasma proteins from the blood into the urine. Such kidneys will slowly fail and their contribution to a healthy body will decline. The blood pressure goes up. Red blood cell production falls and anemia results. These losses of health occur together, and contribute to the clinical expression of diabetic renal disease.

When the long nerves of the limbs are affected by glycation (especially in the legs) the patient develops symptoms of numbness and tingling as the earliest expression of their neuropathy. Sensory perception is reduced and the skin’s ability to recognize pain and damage is lost. Toes become vulnerable to painless wear and tear during the day, so all diabetics should examine their feet closely every bedtime, and give immediate protective attention to injuries or breaks in the skin.

The sugar-protein complexes of glycation also damage arteries. They disrupt the intima, a delicate film that lines all arteries, disturbing its integrity and allowing more cholesterol to penetrate the artery wall. So atheroma builds up, and diabetics become prone to earlier heart attacks and strokes. In the legs, diabetic artery problems combine with neuropathy, and lead to dead toes or a dead foot that must be amputated.

A damaged diabetic toe lives in a dense environment of dirt bacteria that are ready to invade any random break in the skin. Trouble is often first noticed when a sock sticks momentarily during its removal at bedtime. An ulcer forms, the toe darkens, while normal defenses against infection are now handicapped by a poor circulation. Gangrene appears. In the US today, diabetes underlies most surgical amputations of a foot. Sadly, the surviving foot is almost as vulnerable, and usually lost within a few years of the first.

Glycoprotein complexes also form with the hemoglobin of circulating red blood cells. Clinicians have turned this particular sugar-protein ‘complication’ to their advantage, making it an indicator of the quality of sugar control in patients as they live their daily lives. Hemoglobin glycation  changes less briskly than the blood sugar, making it a better general guide to over-all glucose control day-to-day. Called Hemoglobin A1c, its levels in a diabetic’s blood should ideally be well under 6%.

Most of the body’s muscle mass and large blood vessels are located below the waist, in the legs. Daily walks increase their blood-carrying capacity, their blood supply, and over time help cushion diabetic patients against damage to the toes and feet. Daily walks are a good start. No one, especially diabetics should remain seated beyond an hour anywhere, without getting up and moving around.

To help keep blood sugars from going too high at mealtimes, diabetics learn that not all carbohydrates are created equal. The complex ones as in vegetables and whole grains are best. They take longer to digest and dismantle, so their effect on the blood sugar is slower and lower. They should be eaten over the day. Beyond oatmeal for breakfast, think of breakfast vegetables…like a simple sweet potato or bean stew. Simple sugars tend to spike blood levels and are best avoided.