Monday, 30 November 2009
Thursday, 19 November 2009
We started in a corner of town containing solemn reminders of events that took place in WWI
Half Way up
Towards the end of the walk we passed through the the necessary but ugly industrial area which is a common feature on the outskirts of most French towns. We took no pictures of fromage de france or the sausage factory .We were drawn to what appeared to be a monastery overlooking the prefabricated factory buildings. As we got closer we heard the sound of music from the church. It was the community singing the office. We didn't go in, but stood outside for a while, finishing out walk as we started with quiet reflection.
Sunday, 15 November 2009
It was good fun to join in with people from all over the world and take part in the Big Blue Test . I'm very certain that exercise plays an important part in my control. My glucose levels tell me when I've been lazy but I've often got the impression that, I'm a bit unusual, that other people don't really think it makes much difference. Diet is what matters most, not what you do. In fact, when I posted details of the test on one forum, I was really disapointed, the only response. was a couple of metaphorical yawns concerning the whole idea of World diabetes day
Before 14 minutes exercise
After 14 minutes exercise
So a drop from 6mmol to 4.3mmol, a distance of 5.5 laps, thats 1.39 miles and 67 kj -I think that was about 160 calories.Just slightly under 10 min miles, which is very fast for me. The test was probably a bit close to lunchtime but I was pleased to only fall to 3.8 later in the afternoon (so a small bit of aero with a cup of coffee was all that was needed to keep me going 'till dinner.
I uploaded my results to the site, at that time there weren't that many so it was great to log back on this morning and find lots had taken part. There were of course lots of results from the US, but there were lots of other countries represented Saudi, the Philipines, Germany, the Netherlands, the UK and South Africa were some I noticed.What struck me straight away was that so many people had seen falls in such a short period of time. Some were totally surprised, others very happy. There were all sorts of activities. People were hula hooping on the wii fit, walking, biking, running , stair climbing, house cleaning, playing with children, skipping, chopping wood and doing exercises in a chair. Some people did far more than 14 minutes, long bike rides, runs and walk
What an eye-opener. Before exercise, 147, after walking on treadmill for 14 minutes, 108. What an incentive to take care of myself while I am in early stages
My exercise was folding laundry as I am not able to exercise heavily, started with 8.6 mmol/L and after 14 minutes it was 6.7 ;
how amazing112 and 106 after 14 minutes of walking on the treadmill. With one added note, I had a late lunch ( I was less than an hour post meal) so my BG should have been going up.
I was 139 and after 14 minutes on the exercise bike was 93! I find that if I pedal really, really hard I can get my BG down in about 10 minute.
Well Done Everybody
Looking at all the figures I thought I'd try and put them together to show how effective the short period of exercise had been, It's not a scientific exercise, people whose levels had gone up might not have posted their results, others might not have paticipated because they had previously seen their levels rise with exercise. I only included people who seemed to have done the 14 minutes (I left out those that said they did longer)
Then I put the results in order of the first reading and plotted the results on a graph.
I think this exercise really showed how well exercise works for many of us with Diabetes, thankyou Manny Hernandez andTu Diabetes.
World Diabetes Day Part 2
In the evening we went to Cahors to see the lit up Marie and bridge. Unfortunately the filters weren't really strong enough for the job and my camera wan't really up to it either. It was also pity that there wasn't anything to tell people why the lighting had been altered. When we crossed the bridge a local was obviously a little puzzled. He kept stopping and peering over the parapet at the lights perhaps wondering as to why they weren't as bright as usual. Later in the restaurant we talked to the waitress. She knew about it as it had been on the local radio.
Blue Town Hall
Friday, 13 November 2009
My French lab reports the results in g/l rather than the milligrams per decilitre used in the US or mmol/l used in the UK.
5mmol/l in the UK would be 90mg/dl in the US but when I visit my French doctors I would say 0.9 g/l
(and sometimes I give the mmol/l figure and cause great confusion)
Somehow grams and litres, being everyday measurements makes it much clearer than either millimoles per litre or milligrams per decilitre.
Not very much really; dissolve it in one litre of water and it would barely sweeten it to taste. I would have had about 5-6 times that in my whole body (in the UK that equates to about 21.5 mmmol/l)
(I'll get back to the glucose variations soon, it's a hard one to write)
Sunday, 8 November 2009
In an earlier blog I pointed out some of the reasons that people using insulin can have rollercoaster blood glucose levels from time to time, is it these variations that lead to complications?
I got interested in this after seeing a study in this month’s Diabetes care which investigated the association of A1C levels and fasting plasma glucose (FPG) with diabetic retinopathy and how well the two measures discriminated between people with and without retinopathy. Out of the 1,066 individuals, 11% them had retinopathy. (Retinopathy was defined as level 14 or above on the Early Treatment Diabetic Retinopathy Study severity scale. Level 14 equates with mild non proliferative retinopathy.) They found that HbA1c was the better discriminator and that the steepest increase in retinopathy prevalence occurred in people with a relatively low A1C of ≥5.5%.
At first sight it seems quite shocking, retinopathy with a Hb A1 of 5.5%, that’s well within my laboratories normal range . On reflection, it shouldn’t really cause any surprise as the DCCT (Diabetes Control and Complications Trial) showed a small number of subjects with complications at this level. The probability of it progressing is small, but that ‘chance’ still exists.
A small number, but it represents real people who wonder why it had to happen to them.
It happened to me, I was horrified to be told that I had some mild background retinopathy. I had been diagnosed for 4 years, I had checks every year for 3 years with nothing found. Then, before going on the pump. I had to have an extra check using fluorescein dye. This was a compulsory part of the procedure in France, and is because many people going onto pumps have quite high glucose levels. The change to pumping can lower levels rapidly and this can cause rapid progression of retinopathy. The angiogram, would show if care was necessary in reducing levels. My 'problem' wasn't high levels though but hypos and an active lifestyle. Both my doctor and I thought that it would be a formality. Fortunately, the changes were slight, but they were clearly there.
In her blog,* Jenny Ruhl discusses some theories why a person with a lowish HbA1c might develop retinopathy. She points out that an HbA1c can be the result of very different day to day patterns of glucose levels.
Two patterns that would result in the same Hb A1c, one clusters around the mean, the other has far larger glycemic excursions
She suggests that the ‘normal people’ in the study who had early retinopathy might have higher postprandial levels (fuelled by a high carbohydrate diet) followed by lower levels, such people could be be experiencing ‘oscillations that veered between 75 and 150’.( 4.2 and 8.3).
In contrast she suggests that people who control their diabetes well might different patterns. She describes a ‘ pattern in which the blood sugar stays near 112 (6.2mmol) all day long,' or alternatively , one with a relatively high fasting glucose of about 110 (6.1mmo) ,very narrow fluctuations at meal time, perhaps up to 120(6.6mmol) and then back down to 90(5mmol) . This she suggests is a pattern achieved by reduced carbohydrates plus necessary oral medication or insulin..
She implies that day to day and within day glucose variability as characterised by the first pattern might help to explain the incidence of retinopathy at relatively low HbA1c levels . In other words the ups and downs are important.
Jenny Ruhl advice is to’ keep track of your post-meal highs and keep them under 140 mg/dl as much as possible’ and this is surely the safest course and what most of us try to do. By doing this the overall average blood glucose level and presumably the Hb A1c is kept down. Yet increasingly some doctors and diabetes authorities are saying that those people who don’t need to adjust insulin doses should be concerned with the overall HBA1c and not the day to day variation. Moreover, there are many people, particularly type 1s who find it very difficult to limit their glucose excursions to a narrow band, too low post prandial levels, too low levels before exercise or before bed can result in serious hypos, a much more immediate complication. Thinking about this lead to some big questions
· Is day to day and within day glucose variability more significant or as significant as HbA1c in the development of complications?
· Is it the same answer for both micro and macro vascular complications?
· Is there a difference between type 1 and 2 (LADA, MODY???)
Back to my personal interest.
When background retinopathy was discovered my HbA1c taken a week before was 4.9% Since diagnosis it had been in the low 5s. I rarely had recorded glucose levels over 140, I had a fair number of hypos, almost always during exercise and very quickly remedied. At the time I was going to bed at about 80mg/dl...so for at least 10 hours of the day my level was ‘normal’ .
Now it is possible that the retinopathy was there before diagnosis and only became visible with the more detailed examination. Was I simply unlucky, or did the blood glucose excursions to below 70mg/dl and back up to normal levels play a part?
I’ve been trying to find the answers to those questions.
Like everything, it seems to depend on who you ask! (Or rather what you read)
To be continued...........!