The Hypocritic Oath

Diabetic Complications – The Motherlode

Posted in Uncategorized by trinkwasser on September 1, 2009

This is an oldie but goldie

Oxidative Stress and Stress-Activated Signaling Pathways: A Unifying Hypothesis of Type 2 Diabetes

Joseph L. Evans, Ira D. Goldfine, Betty A. Maddux and Gerold M. Grodsky

Make a fresh jug of coffee before approaching it, and you may need to stop for a nap part way through, it’s pretty intellectually dense but is an outstanding overview of the many destructive pathways involved in diabetes (some but not all also common to Type 1)

On the same subject

Lifestyle-induced metabolic inflexibility and accelerated ageing syndrome: insulin resistance, friend or foe?

Alistair VW Nunn, Jimmy D Bell and Geoffrey W Guy

What this paper seems to be saying (it’s also pretty dense) is that some of the damage pathways are only so when chronically activated. In acute mode they are probably useful, like an emergency stop, which may be the reason they evolved.

As an analogy from my trucking days, if you hit the brakes you can stop surpisingly quickly. But if you try to hold your speed going down a hill or mountain you’ll rapidly run out of capacity to dissipate the heat generated and your brakes will fade or even catch on fire.

So you have to find an alternative mode to control your speed in chronic mode from that which works acutely: downshift and hit the exhauster or Jake brake (buses and coaches may use an electric or hydraulic retarder) all of which systems are designed to dissipate energy in a long term way, and keep the wheel brakes for emergencies.

That’s a pretty neat analogy for current diabetes treatment (well I think so!) Stay in overdrive (feeding your face with carbs) and bring down your BG with heroic quantities of medication, and oh dear, your cardiovascular system burns out (ACCORD)

Use the brakes before you get to the downgrade (take meds if needed initially to bring your BG into range) then get into the right gear (low carbs) and you won’t trigger the shutdown systems.

Speaking of ACCORD here’s a recent antidote: an update on the UKPDS

10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes

Rury R. Holman, F.R.C.P., Sanjoy K. Paul, Ph.D., M. Angelyn Bethel, M.D., David R. Matthews, F.R.C.P., and H. Andrew W. Neil, F.R.C.P.

Conclusions Despite an early loss of glycemic differences, a continued reduction in microvascular risk and emergent risk reductions for myocardial infarction and death from any cause were observed during 10 years of post-trial follow-up. A continued benefit after metformin therapy was evident among overweight patients.

So there you go, these patients had learned how not to burn out their brakes.

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2 Responses

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  1. JimmyBean said, on October 1, 2009 at 4:03 pm

    I don’t know If I said it already but …Cool site, love the info. I do a lot of research online on a daily basis and for the most part, people lack substance but, I just wanted to make a quick comment to say I’m glad I found your blog. Thanks, 🙂

    A definite great read..Jim Bean

    • trinkwasser said, on October 2, 2009 at 11:50 am

      Your comment was flagged as “spam” but I approved it anyway, not only because you said nice things about me 😉 but because it gives me the opportunity to say, if you like information then do read Whole Heath Source and Hyperlipid, listed in my blogroll.

      These are probably the most information-dense of my sources, my brain is still cooling down from reading them both end to end and I still have half a gazillion papers awaiting reading from their references.

      One reason I haven’t posted much for a while.


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