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Friday, June 14, 2019

How Does Hyperglycemia Cause Damage And What Can We Do To Avoid It?

I have read many research papers since my diagnosis seventeen years ago but until very recently I had never seen a research paper specifically addressing in detail the subject of how and why high blood glucose levels cause harm to our bodies. It seems to me that understanding that is basic to finding better ways to maintain long term diabetes health.


The scientists were interested in discovering the effects of hyperglycemia on endothelial cells and how that contributed to the development of vascular complications of diabetes. They were also looking for methods to reduce those effects.

As I am not a biochemist I found the Warwick report analysis of the paper more understandable. This is the section I found particularly interesting:

Hyperglycemia is the condition in which an individual’s blood glucose is abnormally high and is commonly caused by diabetes.

The researchers confirmed that glucose metabolism in endothelial cells is increased in high concentrations of glucose. They showed for the first time that this occurs because an enzyme that metabolises glucose in these cells, called hexokinase-2 (HK2), degrades more slowly in high glucose concentration and thereby metabolises more glucose than normal. Increased glucose metabolism is the driver of metabolic dysfunction of endothelial cells in model hyperglycemia.
They were able to correct this effect using a novel dietary supplement previously developed by the research team called a glyoxalase 1 inducer or Glo1 inducer.
They also found that the HK2 effect was the major mechanism increasing formation of a reactive glucose-derived substance called methylglyoxal (MG), known to be increased in diabetes and linked to damage to blood cells, kidneys, retina and nerves in arms and legs in diabetes – so-called vascular complication of diabetes.
MG binds and modifies proteins, causing them to become misfolded. In this study the researchers identified 222 proteins susceptible to MG modification and this activates a protein quality surveillance system called the unfolded protein response, which removes damaged proteins. When the unfolded protein response is overworked with a high level of misfolded protein substrate it causes an inflammatory response and there is an increased risk of blood clot formation. These processes contribute to blood vessel damage involved in the development of vascular complication of diabetes.
My focus is slightly different. The scientists found a dietary supplement may help; to me that might be useful some time in the future but is much less important than this: “When the unfolded protein response is overworked with a high level of misfolded protein substrate it causes an inflammatory response and there is an increased risk of blood clot formation. These processes contribute to blood vessel damage involved in the development of vascular complication of diabetes.
Over the years since I first began using Jennifer’s Test, Test, Test method to modify my menu I have slowly formed the opinion that maintaining peak post-prandial blood glucose levels as close to non-diabetic as I reasonably can is much more important than other tests such as A1c or fasting blood glucose.

I believe this research adds support to my ideas but I emphasise the following is purely my personal opinion as a long term type 2 diabetic.
  • Our bodies have a natural ability to heal most wounds or damage with time.
  • Short term blood glucose spikes above high normal (~8 mmol/l or 140 mg/dl) cause immediate damage. The higher the spike, or the longer it is maintained, the worse the damage. 
  • I believe that damage can be repaired by our body given sufficient time but repeated frequent hyperglycemia can have a cumulative effect if the damage exceeds the body's ability to repair it in time.The body needs periods of normal blood glucose level to repair past harm. Constantly elevated blood glucose levels, even if only slightly above normal, impair the body's normal healing processes.

Put those thoughts together and I see a need to concentrate on two separate but allied blood glucose goals:
  • I aim to maintain steady blood glucose levels as close as is reasonably possible to non-diabetic. 
  • Avoiding brief blood glucose spikes is wise but nobody is perfect and they will happen. I aim to minimise their frequency and level.
My personal definition of a non-diabetic range is 4-8mmol/l or 70-140 mg/dl. 

In my own experience reducing post-meal spikes also improved my steady levels between meals. For that reason I have concentrated on minimising post-meal spikes as my main treatment goal. I suffer from dawn phenomenon but I do not get too concerned about fasting blood glucose provided it is not too high and peak post-prandial results are good; to me fasting blood glucose is a diagnostic indicator rather than a management tool.

Provided my levels between blood glucose spikes are good I don't get too excited when occasional spikes occur. Instead I try to learn from them and discover the cause and try not to repeat them.

I practise what I preach. My doctor's report has changed very little since I wrote this in 2015Are Diabetes Complications Inevitable? Not necessarily...

Cheers, Alan, T2, Australia.

Everything in Moderation - Except Laughter 
There Is Nothing I Could Eat I like More Than my Eyes

Thursday, January 18, 2018

Slow Cooked Beef Brisket

I bought my first slow cooker a few weeks ago. In the past I used stove-top large saucepans for slow cooking and braising. The method worked but needed regular stirring to prevent sticking. When a post-Christmas special appeared for a very cheap large slow cooker I decided to give it a try.

I wish I’d bought one years ago! I have experimented a few times now. I prepare the veges and meat after breakfast, toss them and some stock and liquids in the cooker and lift the lid eight or nine hours later for a delicious dinner.

This is my favourite of the recipes I have tried so far. It didn’t occur to me to take pictures last night; I will add them next time I cook it.

Beef Brisket


Ingredients

Portion sizes, herbs etc are flexible. Adjust to suit your own taste.
  • 1-1.5Kg (2-3lbs) beef brisket or any similar cut. I prefer a piece at least 2-3cm (1”) thick and roughly rectangular which fits comfortably in the cooker.
  • 1 large or 2 medium onions, sliced.
  • 1 large or 2 medium carrots.
  • 1 cup chopped celery
  • Chopped herbs to taste. I used parsley, thyme, rosemary and mint from my garden.
  • 2 or 3 bay leaves.
  • 1 teaspoon mild paprika.
  • 1 cup red wine.
  • 1 can (400gm, ~1lb) chopped tomato.
  • 1-2 cups beef stock (or pork or chicken; I make my own from bones and herbs).
  • 2 cloves garlic.
  • Salt and pepper.


Optional: 3-5cm (1½ “- 2”) chunks of potato.


Method

Serves 4 or more  depending on appetites and portion sizes.

Slice the carrots lengthways, cut them into rough chunks and place them on the floor of the cooker to become a base for the meat.

Roughly trim excessive fat from the beef. Leave some on for flavour. Lightly salt both sides of the meat and place it in the slow cooker. Grate some pepper over the meat to taste.

Fry the onions in oil in a skillet until soft, add the chopped celery and minced garlic and continue frying until the onions are starting to brown then transfer the cooked veges to the slow cooker.

Deglaze the skillet with the cup of wine and add the liquid to the cooker. Add the paprika, chopped tomato and stock. Stir to mix the liquids and settle the meat among the veges. If necessary add water sufficient to come just level with the meat.

Cook on low for 8 or more hours (my cheap cooker has only three heat settings: low, high, keep warm). As my spouse likes potatoes I added some chunks into the liquid around the meat at the 4 hour mark. Possibly those could be included at the start.

Serving.

Gently remove the meat from the cooker, trying not to remove too much attached liquid and veges as you transfer it to a cutting board.

Using a slotted spoon remove the carrots (and potato if added) from the sauce and transfer them to a serving dish. Don’t get too fussy if some liquid and other ingredients stick to the carrots or potato.

Remove the bay leaves and blend the remaining liquid and contents with a stick blender to become a smooth sauce. Use a potato masher if you don't have a stick blender. It doesn't have to be perfect.

Carve the meat across the grain into roughly 6mm (1/4”) slices and transfer to a serving dish. Pour the sauce liberally over the meat.

Diners serve themselves from the dishes.

I have not worked out the carbs, fat etc but the main carbs are in the onions, carrot and potato if added. This did not even cause a blip in my 1hr post-meal blood glucose test.

Bon Appetit

Cheers, Alan, T2, Australia.
Everything in Moderation - Except Laughter
There is Nothing I Could Eat I like More Than my Eyes

Saturday, October 22, 2016

What is a Balanced Diet For a Type 2 Diabetic?

This question came up on one of the forums I am on recently. There were many conflicting responses, often including discussion about various macronutrients (fat, protein, carbohydrates) and micronutrients (minerals, vitamins etc), the evils of sugar, cholesterol and saturated fats, the need for lots of fruit or grains etc etc. A lot of people also went into great detail about maximum and minimum percentages for fats, carbs and protein.

I believe in KISS, so I try to keep it simple with easy to follow rules for my way of eating. As I have to eat this way for the rest of my life I do not want an excessively complicated food selection system.

My definition of a balanced diet for a type 2 diabetic (me) is pretty basic and not in terms of percentages of anything. The basic description is simple, although the personal investigation creating the way of eating I follow today was fairly complex. The links at the foot of this post describe the journey to this point.

The simple version:
  • I let my meter show me my carbohydrate limits for the time of day and the meal.
  • I let common sense and satiety limit my protein and fat portions.
  • I include a reasonably wide variety of vegetables in my menu, favouring fresh and seasonal vegetables where possible.
  • I also include fruits but those are limited to minimise blood glucose spikes.

In applying those basic rules for myself I also take these factors into account:
  • Variety in choices of meats, fish, seafood, dairy, vegetables and fruits makes the menu interesting and also improves the chances of getting all needed vitamins and micronutrients.
  • Excess of any macronutrient is not wise.
  • Excessive restriction of any macronutrient is just as unwise.
 These links to past posts expand on those points and others: 

Cheers, Alan, T2, Australia.

Everything in Moderation - Except Laughter 
There Is Nothing I Could Eat I like More Than my Eyes