Coronary Artery Disease, Diabetes: 80% Insulin Making Cells Ruined, Root Causes
Few disease conditions are so thoroughly intertwined as coronary artery disease (CAD) and diabetes. The link between diabetes and heart disease is well-established. If you have diabetes your CAD risk skyrockets. More importantly, even without a diagnosis of diabetes, you may still have a significantly elevated risk. Once again, it is time to practice Informed Self-Directed Healthcare (ISH) to not only save your life but save your quality of life by acting now, BEFORE you have full-blown diabetes leading to CAD complications. We have the technology!
I recall how my personal physician pooh-poohed the idea of technologies like heart scans and insisted that my low LDL was all the assurance I needed that CAD was not likely to be in my future. I went out and got a heart scan anyway (it was positive) and then engaged a top traditional cardiologist who performed a nuclear stress test. He also insisted I was fine but I became suspicious of statements like, "If you are still worried take a statin, they're "magic" (his words not mine). Wrong! Fortunately, I discovered doctors like William Davis, Bill Blanchet, Arthur Agatston, Harvey Hecht and programs like Track Your Plaque that go well-beyond old school cardiology to uncover the root causes of heart disease - my personal causes - not some "one-size-fits-all" statin solution.
My own recent problems with blood sugar control led me to do some intense investigation on the subject much like I did when my first heart scan revealed the very earliest stages of CAD. Here is what I found.
1. Like heart disease, diabetes is not some "you have it or you don't" disease. It is just as insidious and creeps up slowly, often undetected. Just like heart disease, by the time you are diagnosed with diabetes via traditional medicine up to 80% of your insulin producing pancreatic beta cells may be destroyed or impaired. You need to both diagnose the early beginnings, the "prediabetes" stage (kind of like the "pre" heart attack, stent, and by-pass stage of heart disease), and take steps to forestall progression to frank diabetes and a lifelong insulin injection dependence.
2. You do not have to settle for treatments that only address the symptoms of diabetes with treatments like sulfonylurea, metformin, and insulin. You can test and treat the root causes of diabetes, deterioration of pancreatic beta cells and insulin resistance, with new assays, lifestyle interventions, and, yes, new drug regimens.
3. Until I find a program similar to "Track Your Plaque" for conquering diabetes (and a list of doctors who can help you navigate the technology) by employing ISH here a few of my personal findings and guidelines.
- Ignore "normal" fasting blood sugar tests. They are not an accurate assessment of blood sugar control. Get an Oral Glucose Tolerant Test (OGTT) which measures your post-prandial glucose response (make certain they also measure insulin levels at the same time). Alternately, get an HbA1c test. This provides a measure of your "average' blood sugar level over the last three months. If your doctor won't order either test, get a blood glucose meter (as little as $15) and test your blood sugars for 2-3 hours after several meals. You can also buy home test kits that measure your HbA1c.Don't rely on a negative diagnosis of diabetes or even Impaired Glucose Tolerance (IGT). Most doctors simply look at a chart and make a diagnosis. You need to know how close to the clinical definition of diabetes you are to assess what intervention to perform. Like early heart disease (or most any progressive disease), the earlier you treat it the better the outcome.
- Traditional treatments such as metformin and sulfonylureas do not have long-lasting or durable effects. Over time, they become less effective until insulin injection is the only option. Of course, exogenous insulin supplementation has its own problems.
- Don't buy the traditional recommendation that controlling your HbA1c to under 7.0% is a proper treatment goal. Studies have shown the beginning of diabetic/arterial complications such as retinopathy at levels down to 5.9%. The moral of the story is lower, say 3-4, is far superior.
- Remember, diabetes is primarily caused by two things, your ability to produce sufficient insulin and how effective your insulin is in reducing your blood sugar (certain intestinal, liver, and kidney functions also contribute to glucose control but I'll save those for another post). You need to act now to preserve your pancreatic beta cells which produce insulin. Here are some cutting edge treatments to discuss with your doctor.
Have a long and frank discussion about these TZDs (and ALL treatments, drug or otherwise) with your doctor as they have been negatively associated with some heart disease risk factors. Other studies have found there may be cardiovascular benefits by enhancing insulin stimulation of Insulin Receptor Substrate-1 (IRS1) as well as inhibiting Mitogen-Activated Protein (MAP) kinase pathways.
GLP-1 is a protein produced in the intestine that performs many useful blood sugar control functions such as increasing insulin secretion in a glucose-dependent manner, decreasing glucagon secretion, and increasing beta cell mass and insulin gene expression.
GLP-1 deficiency and beta-cell resistance to GLP-1 occur early in the progression to diabetes. Using GLP-1 agonists (Liraglutide, Exenatide: originally isolated and extracted for Gila Monster saliva!) should theoretically help restore GLP-1 levels and provide enhanced glycemic control.
Dipeptidyl Peptidase-4 Inhibitors
Dipeptidyl Peptidase-4 (DPP-4) inhibitors (Sitagliptin, Vildagliptin), also maintain GLP-1 levels by blocking GLP-1 catabolism and are reputed to reverse a number of pathogenic processes that that are typical of diabetes.
Remember, diabetes is a common casual factor in the progression of heart disease perhaps second only to smoking. The "take away" knowledge here is to not wait until you have a diagnosis of diabetes. Practice a little ISH and act early to diagnose your true glucose control condition then work persuasively with your doctor to take full advantage of everything cutting edge medicine has to offer.
Looking out for your heart health,