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Every Month: a Review of Major Teaching Points

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A Power Program for Student Review

Course Coverage 2015

  • Jan Fit To Last
  • Feb Visceral Obesity
  • Mar Modern Malnutrition
  • April Metabolic Syndrome
  • May Prevalent Predicaments
  • June Sugar Diabetes
  • July Diabetes Complications
  • Aug Cholesterol, Atheroma
  • Sept Aging Brain & Body
  • Oct Cancer Considerations
  • Nov Feeling Liverish
  • Dec Energetic Longevity
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At elevated blood levels, glucose molecules form distorting sugar-protein complexes by reacting with selected tissues. Called glycoproteins, the complexes so formed slowly degrade the affected tissue’s ability to function. Cellular organization is distorted and organ performance gradually compromised, leading for example, to blindness and kidney failure.

In the eye, glycoprotein complexes of the retinal capillaries lead to ‘dot and blot’ bleeding…and to tiny cloud-like puffs of serum exudate. They come and go in severity, and often interfere with vision. In the US today, diabetes has become the most common cause of new cases of legal blindness.

In the kidney, microscopic filtration systems called renal glomeruli, are progressively damaged by glycation. The damaged kidney filters begin to leak plasma proteins from blood into the urine. As such kidneys slowly sicken and fail, their contribution to a healthy body declines. The blood pressure goes up. Red blood cell production falls. Hypertension and anemia develop. These losses of health occur together, and all contribute to the clinical expression of diabetic renal disease.

When the long nerves of the limbs are affected by diabetes (especially in the legs) they often begin producing symptoms of numbness and tingling as the earliest evidence of neuropathy. Sensory perception is reduced. The skin’s ability to recognize pain is lost. Toes become vulnerable to painless damage during the day, so diabetics should examine their feet closely at bedtime each evening, and give immediate protective attention to any injury or break in the skin.

Damaging sugar-protein complexes disrupt the intima, a delicate film of tissue that lines all arteries. By disturbing intima’s integrity, diabetic glycation allows more cholesterol to penetrate the artery wall where atheroma builds up. For this reason diabetics are prone to earlier heart attacks and strokes. In the legs, diabetic artery problems combine with neuropathy, and lead to dead toes and dead feet that must be amputated.

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

Glycoprotein complexes tend to 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. Its levels change less briskly than do those of 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 circulation are located below the waist, in the legs. Daily walks increase their blood-carrying capacity, their blood supply, and over time can help cushion diabetic patients against damaged toes and feet. Daily walks are a good start, and never 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 (not the sugars), as in vegetables and whole grains, are best and should be eaten over the day. They take longer to digest and dismantle, so their effect on the blood sugar is slower and lower. Beyond oatmeal for breakfast, they should begin to think of vegetables…like a simple sweet potato or a bean stew. All sugars tend to spike blood levels and are best avoided.