3) THE BASIC CAUSES OF TYPE 2 DIABETES
h) Protein Poisoning and A1c
The so called "A1c" blood test for diabetes, the type 2 diabetes test all physicians rely on, is actually is just a measure of the poisoning ("glycation") of certain of the blood proteins of the red blood cells by sugars over a span of two to three months (the literature is conflicting on the time span, the latest ADA position statement says two to three months). It should be noted that both exercise and lowering one's weight decreases insulin insensitivity. Because an individual with a lower weight who exercises absorbs sugar into their cells more easily (i.e. they have decreased insulin insensitivity), the level of sugar in their blood will be lower and their A1c will be lower. So exercise and/or weight reduction will reduce protein poisoning and A1c.
In the past endocrinologists thought that the protein poisoning rate is directly and linearly related to the average of the sugar level in the blood. This averaging effect is one reason endocrinologists are more interested in A1c and "before meals" ("pre-prandial") and fasting sugar levels than in the sugar levels one or two hours after a meal. Thus most but not all endocrinologists felt that an occasional "splurge" wouldn't hurt a person with diabetes very much. This averaging affect is also why there was less than enthusiastic endocrinologist endorsement of the glycemic index being used to treat diabetes. By the thinking of most endocrinologists, the glycemic index (see chapter on the Glycemic index) should be thought of as only one of many ways to control weight, which in turn helps with diabetes control.
But recent research is showing this averaging effect is not true. After meal (post-prandial) blood sugar levels are more important than before meal (pre-prandial) blood sugar levels. If an individual has their diabetes under reasonable control (A1c less than 6.6 to 7.0%); then every 1% increase in blood sugar after meals is the equivalent of a 2% increase in blood sugar before meals, i.e blood sugar levels after meals have twice the effect on A1c as blood sugar levels before meals. The effect becomes less as the A1c rises above 7.3% but it is still significant. It appears that even short periods of exposure to sugar levels of 140 to 200 can be damaging. And exposure to levels above 200 can be extremely damaging. A1c measures red blood cell protein poisoning and red blood cells are rapidly exchanged and constantly rebuilding their protein structures. Cells such as nerve cells are much slower to recover from any episodes of high blood sugar, if they ever recover.
There have been several retrospective studies which have shown high postprandial (after meal) blood sugar levels increase the incidence of heart disease. The STOP-NIDDM study of Acarbose demonstrated that lowering after meal blood sugar levels reduced heart attacks by 49%, reduced the new diagnosis of high blood pressure by 34%, and delayed progression of hardening of the arteries among patients with impaired sugar tolerance. In the German Diabetes Intervention Study, lowering after meal high blood sugar had a greater effect on heart attack mortality than did lowering before meal blood sugar among patients with type 2 diabetes.
It also appears that a spike of blood sugar into the high ranges can produce protein poisoning for 24 hours or more after the sugar level has returned to normal. A high level of sugar in the blood causes the blood proteins and the other body proteins to absorb large quantities of sugar. This absorbed sugar then poisons the proteins over an extended period of time. So, if a person with diabetes wants to be safe, they probably need to avoid splurges and high glycemic index foods which take the blood sugar to high levels. If an individual with type 2 diabetes who is not on insulin is contemplating a "splurge", it is a good idea to get the flow of insulin going by eating protein or by taking a Meglitinide drug (Prandin™ or Starlix™) half an hour before the splurge. If the type 2 diabetic is on insulin, they need to inject insulin accordingly.
A1c is a measure of damage to the body by sugar induced protein poisoning ("glycation") and is thus the "gold standard" of tests. However A1c does not necessarily correlate well with the standard sugar meter test. The most common sugar, sucrose ("sugar", "table sugar" or "cane sugar"), breaks down into fructose and glucose sugars in the body. Fructose is also present in all fruit. Fructose sugar poisons protein just as well as does glucose. And fructose does not register on a standard glucose meter. So someone with type 2 diabetes who eats a lot of table sugar or fruit can be severely damaging their body and not know it. If an individual with type 2 diabetes has consistently low glucose meter readings but a relatively high A1c, it might well be due to consumption of either too much standard table sugar or too much fruit.
It is somewhat difficult to generalize on what fasting sugar levels produce what A1c levels but general correlations can be made. An average fasting sugar (glucose) level of 90 might produce an A1c of 5% while an average fasting sugar (glucose) level of 150 might result in an A1c of 7%. Some endocrinologists want patients to aim for the 5.5% A1c level, not the 6.5% recommended by most endocrinologists and the 7% recommended by the ADA. This can be achieved largely by drastic weight reductions and strenuous exercise. David Mendoza (his website, http://mendosa.com/ is very good) got down to 4.9 A1c largely by just such effort.
Current Chapter: 3) THE BASIC CAUSES OF TYPE 2 DIABETES
a) Underlying Mechanism of Type 2 Diabetes
b) Symptoms of Type 2 Diabetes
c) Tests for Diabetes
d) Insulin Resistance
e) The Complexity of Diabetes
f) Poisoning of Body Protein
g) Diabetes, Protein Poisoning and Cognitive Thinking
h) Protein Poisoning and A1c
i) Well Cooked Meat and Protein Poisoning
j) Beta Cell Death in Type 2 Diabetes
k) The Hypoglycemic Spike Effect
l) The "Dawn Phenomenon"
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