Tuesday, October 2, 2007


Whats the deal? Tonight I had two patients,one in for an infection and the other with chest pain. Both had difficulty with controlling their individual problems. No other complaints told to the triage nurse and I attempted to take care of the two separate issues, but upon discussing what to do next with each of them, something told me to check a sugar level and....both of them were in the 300+ range and both were obese. Both were admitted diabetics for at least 10 years each. It turns out both were on insulin. The gentleman had insurance and wasnt checking sugars daily but stated he was last in his doctors office about 6 months ago. The ADA states to get a hemoglobin A1c every 3 months, so thats at least a visit for a blood test. I asked what is daily calorie intake was and he said about 3000. After I picked my jaw off the ground, I mentioned that a normal person is 3000- 3500 cal per day. He says it's "hard". I gave him the reality scenario of having silent ischemia from heart disease and diabetes and that dont count on doctors missing his heart, he will live and doctors will have him on machines and medicines. He will live a lousy life if it gets to that point and it will unless he changes his goals. He was more worried about getting a pain shot for his low grade back pain than the bronchitis in his chest or the chest pain. I explained that the muscles in the back and the bones in the back wont heal if sugar is constantly floating around in the blood stream and not getting into any cells the heal.

The young lady was in for a new absess to her neck and was a very nice person, she had a different story. Alot of stress lately with death of her dad, no insurance since then, no job. Had last vial of insulin but couldnt pay for new vial. Had been losing weight and was at about 100 lbs. off since 1 year. Told her that infection is the begining, with the sugar being so high and not being able to get one drop of glucose into the little white blood cells that fight infection, I could virtually give her all the big gun antibiotics in the world but we wont win since the white blood cells cant finish the job. She broke down and cried and obviously was in alot of stress. Last lecture I gave had a topic of stress and I explained how stress brings on more free radicals that produce damage to cell membranes. This leads to poor gland functions, poor organ functions, poor thinking. also opens to infection, worsening diabetes, and cancer. I explained how if sugars arent stabilized and given to the body in regular increments, all organs fail (but they do it very slowly).

Many of the problems with diabetes, blindness, kidney failure, heart attack, stroke, amputation happen due to free radical formation. When diabetics get sugars under control, great but this subset of the population does exceptionally well with antioxidants. Magnesium seems to be depleated due to the high influx of insulin stimulating the membrane cells to change permeability from the failing pancreas so this supplement also help curb wide sugar variations. Finally Chromium and cinnamon seem to make the cells more sensitive to the circulating insulin. The basics always hold true and those would be decreasing total calorie intake in addition to not hitting the body with massive amounts of food followed by times of famine. The presence of food/glucose in the blood stream will start the usual chain of hormones to be released, serotonin, insulin, growth hormone.....when the levels of glucose vary at the extremes of the scale, the hormone response will be in extremes. Think of being in a fight or flight panic, several times a day. Not healthy and would eventually depleat all the hormone supplies causing poor sleep, poor concentration, anxiety, diarrhea, hallucinations. Remember vietnam vets and post tramatic stress disorder. Not just the mind but also led to poor health, poor social skills and poor tolerance for change.

Diabetes is a growing epidemic, almost one in three are overweight in the US. Usually the big three always come together; diabetes, high blood pressure, high cholesterol. And guess what....all related to diet. And guess what else, doctors usually dont have time for nutrition counsel but have just enough time to discuss medication side effects and new prescription use. We werent trained properly in school and residency. And the good nutritionists arent covered by insurance. Thank god for diabetes.org and all the info on the website. Whether on insulin injections or pills or nothing at all, food and diet are always supposed to be the basic building blocks. With all the medicines in the world, if diet isnt changed disease will continue to deteriorate. I am really worried for both of them.