Informed, Self-directed Healthcare (ISH)

HeartHawk Health Guide
  • I spend a great deal of "electronic ink" harping on the subject of "Informed, Self-directed Healthcare (ISH).  In a nutshell, ISH is about spending a little time studying your personal health concerns (using resources like and working with your doctor as a team to solve them.  Remember, your doctor has to study, understand, diagnose, and treat perhaps hundreds of thousands of diseases and conditions and manage hundreds if not thousands of patients.  You have to manage one patient, yourself, and those few health issues that affect you.  Your doctor spends perhaps 10-20 minutes with you once every 3 months.  You are with yourself 24/7!  Like it or not, you are better equipped to make decisions and take actions working as a team with your doctor as opposed to either of you working alone.  Yes, many doctors are loners who prefer not to work as a team.  Fire them and find team mates!

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    Rather than wax rhetoric about what a good idea ISH is, I want to take a more practical approach by offering a series of ISH "How to" Shareposts.  In each post, I will cover a heart disease related health issue that is best solved using ISH concepts.  I'll attempt to not only provide the theory but also provide a plan to apply it in your personal heart disease prevention (and even reversal) program.  Many of the topics will come straight from my personal experience - such as our first topic below which is an extension of an earlier sharepost.


    As I mentioned, your doctor is busy.  They provide the test that seemingly does the most good for the most people.  They cannot spend hours analyzing test results so they develop test limits and make diagnoses based on whether you are over or under a predefined limit.  That bit of background information sets the stage for our first ISH session regarding one of the most well-understood yet also most under-diagnosed contributors to heart disease - high blood sugar.


    No, I am NOT talking about diabetes.  In fact, it is this sort of "test limit diagnosis" that is part of the problem.  I am willing to bet many in this audience have had a fasting blood sugar test.  If it was over 126mg/dL it may have led to further testing to diagnose diabetes.  If it was between say, 100mg/dL and 125mg/dL, your doctor probably advised he or she would "watch" it.  If it was under 100mg/dL it is likely nothing more was said other than "you are normal."  Unfortunately, there is still a good chance you still have an undiagnosed high blood sugar problem that is contributing to your heart disease.


    Like many conditions, high blood sugar is a not situation where you are healthy if you are below a certain number but sick if you are above it - it is a matter of severity.  If your fasting blood sugar is routinely 100-125mg/dL you still have problem.  However, many in the medical community do not diagnose it as a disease.  Of course, there is still more to the story.  My fasting blood sugar was always between 80 and 106 - a pretty safe range, right?  Wrong!


    When you consume food your digestive system converts a portion to glucose in your blood (blood sugar) which, in turn, interacts with insulin to fuel your body.  A diagnosis of diabetes typically occurs when the insulin producing "islets of Langerhans" in your pancreas are either not producing enough insulin to regulate blood sugar or what is produced is not working properly.  Some foods, especially sugars and processed carbohydrates, are very quickly converted to glucose provoking a rapid rise in blood sugar.  Still, a "working" pancreas produces enough insulin to keep things in balance.

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    But, what if your pancreas works well enough to return you to a safe level after an eight-hour fast (the minimum period before a fasting blood sugar test) but still allows dangerously high post-prandial (after eating) excursions?  The upper-limit for suspecting diabetes after a post-prandial blood sugar test is generally around 200mg/dL.  Sadly, a score of 194 is not a heck of a lot better but won't result in a diagnosis of diabetes (I ended up with a new "pre-diabetes" diagnosis of "IGT" - Impaired Glucose Tolerance).  More importantly, for most people, a post-prandial blood sugar test is rarely ordered until a fasting blood sugar test turns up high.  Had I not done a little ISH of my own and presented new evidence to my "team mate" doctor (after firing the "loner") I may never have known until a great deal of damage had already been done.


    The "gold standard" test that confirms most high blood sugar problems of any sort is called the Oral Glucose Tolerance Test (OGTT).  You fast overnight, have your fasting blood sugar tested, drink a specified amount of glucose (tastes like very sweet orange soda) then have your blood sugar tested over a period of two to three hours.  I would also suggest that your insulin levels be tested at the same time as those results can provide information on subtle nuances into your blood sugar situation.


    So what can you do to help yourself like I helped myself?  It will be difficult to convince even a "team" doctor to order this test without a little persuasion.  No ethical doctor is going to order an expensive and lengthy test without good reason.  That is where ISH comes in.  Do a little homework and run your own tests.  It is easier than you think!  Here is what I did.


    Today's technology is amazing.  You can buy home blood glucose meters or order individual home blood test kits over the Internet.  They supply you with a tiny device that pricks your finger (really, no pain, barely the sensation of a mosquito bite), you place a drop of blood on a special card, mail it in and the testing company returns the results directly to you (sadly, dubious politics in the state of New York prevents these kits from being shipped directly to residents - but there are ways around this if you have a friend in another state - and in California you need an order from a recognized health professional - whatever that means).


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    I simply fasted on two successive days, ate high carbohydrate breakfasts and tested my blood sugar an hour or two later.  If you don't want all the hassle of fasting and multiple tests or you want more ammo for your doc you can also order kits that test a blood protein called HbA1C.  This handy tool measures your average blood sugar over a period of months with one convenient test.  Anything over 6.0% is considered suspicious.


    Armed with this new data my doctor had no hesitation ordering the OGTT.  The rest is history and, because I practiced a little ISH, it will hopefully add a little more history to my life.  Don't wait to become a statistic in a system that is becoming increasingly inflexible (just think what will happen if the government takes over).  Take control of your health.  Start now!


    Your consumer health advocate,





Published On: September 01, 2009