Is it Tomorrow, or Just the Endo Time?
OK, bad pun. My apologies.
At my last general practitioner Doc's (GP Doc) visit in August, I got a referral to an endocrinologist (EDoc) to discuss "fasting". Today was the day. Getting to see the EDoc was a mix of boredom and amusement. The EDoc was running about 30 minutes late. All of the check in questions, meds recounts, personal info checks, so they could populate the same EMR where my info resides, was entertaining. The physical check, including my weight (more on that below), was equally entertaining. I apparently have blood pressure, a pulse in my wrist and my foot, and I'd guess a heart beat. I think there may have been more gatekeeper / due dilly stuff. But at last, the conversation.
I know what the usual drill / advice / commentary on being diabetic is. EDoc did all that. He offered to have my HbA1c measured in the office, and I told him I wasn't interested. Raised eyebrow, so I followed with 1) my full boat lab work is due in a month or so, and 2) I really cared more about losing weight and fasting. More usual patter ensued, and like a moth to a flame, he returned to the subject of "what my preferred HbA1C would be"? We're getting closer to what I'm interested in.
My answer was "under 5". Normal, non-metabolically f'd people range 4-6. He told me of "modern times studies that had been done, showing increasing mortality for HbA1C's under 6". Modern is the past decade, and of what I know of the subject, a great deal of understanding has occurred after pre-modern. So far so good. I've read the studies he was referencing, as well as the critiques of the results. So, I asked him the two loaded questions: what were the demographics of the study population, and how were the HbA1c's lowered? "That's a good, and intelligent question.", he said. I was happy, because I was now way past the "Is it plugged in?" stage.
Let me be clear. Hypoglycemia is seriously dangerous, and caused by the drugs. I know, and I'm cautious. And, not dead yet. Orthodox opinion is that T2D is irreversible. Yeah, well ...
The studies were intended to show the benefits of tight, low glucose control, via increased insulin load, for elderly diabetics (yes, I flinched) with existing cardiovascular disease. Yes, more drugs. My suspicion, unexpressed, is that hyperinsulinemia isn't good for you. OK, now we are in a conversation.
My next question was "how can I know my pancreas is still working?". My preferred outcome was a c-peptide blood test, which my GP Doc declined to order on my asking. "Ask your endo". I did, we discussed it, as well as how I'd interpret the results. Long story short, I now have the c-peptide blood lab on order.
My next question was about continuing to take metformin, because this ... metformin exercise old people . Right now I'm ahead of him, cause it was new info to him, published 11 Dec 2018. He cut to the chase for me, saying that my HbA1C would go up a bit, my hepatic glucose output might increase, but it was my choice. He told me I could just stop (my eyebrows went up "Cold turkey?"). Yep. This I'll discuss with my GP Doc.
My third question was "What, in your opinion, causes insulin resistance?", and I finally got him amused, because that is the $$Bajillion$$ question. He said if he knew that, we'd all be wealthy and better off. He ran thru the usual list of suspects (genes, metabolic dysfunction at the cellular level), but no one knew for sure. I took the time to lecture about Dr. Jason Fung and his clinical work, overfeeding, and hyperinsulinemia. Full circle.
So, my takeaways from the time:
My plan going forward:
I have a great hobby !! Thanks for listening.
At my last general practitioner Doc's (GP Doc) visit in August, I got a referral to an endocrinologist (EDoc) to discuss "fasting". Today was the day. Getting to see the EDoc was a mix of boredom and amusement. The EDoc was running about 30 minutes late. All of the check in questions, meds recounts, personal info checks, so they could populate the same EMR where my info resides, was entertaining. The physical check, including my weight (more on that below), was equally entertaining. I apparently have blood pressure, a pulse in my wrist and my foot, and I'd guess a heart beat. I think there may have been more gatekeeper / due dilly stuff. But at last, the conversation.
I know what the usual drill / advice / commentary on being diabetic is. EDoc did all that. He offered to have my HbA1c measured in the office, and I told him I wasn't interested. Raised eyebrow, so I followed with 1) my full boat lab work is due in a month or so, and 2) I really cared more about losing weight and fasting. More usual patter ensued, and like a moth to a flame, he returned to the subject of "what my preferred HbA1C would be"? We're getting closer to what I'm interested in.
My answer was "under 5". Normal, non-metabolically f'd people range 4-6. He told me of "modern times studies that had been done, showing increasing mortality for HbA1C's under 6". Modern is the past decade, and of what I know of the subject, a great deal of understanding has occurred after pre-modern. So far so good. I've read the studies he was referencing, as well as the critiques of the results. So, I asked him the two loaded questions: what were the demographics of the study population, and how were the HbA1c's lowered? "That's a good, and intelligent question.", he said. I was happy, because I was now way past the "Is it plugged in?" stage.
Let me be clear. Hypoglycemia is seriously dangerous, and caused by the drugs. I know, and I'm cautious. And, not dead yet. Orthodox opinion is that T2D is irreversible. Yeah, well ...
The studies were intended to show the benefits of tight, low glucose control, via increased insulin load, for elderly diabetics (yes, I flinched) with existing cardiovascular disease. Yes, more drugs. My suspicion, unexpressed, is that hyperinsulinemia isn't good for you. OK, now we are in a conversation.
My next question was "how can I know my pancreas is still working?". My preferred outcome was a c-peptide blood test, which my GP Doc declined to order on my asking. "Ask your endo". I did, we discussed it, as well as how I'd interpret the results. Long story short, I now have the c-peptide blood lab on order.
My next question was about continuing to take metformin, because this ... metformin exercise old people . Right now I'm ahead of him, cause it was new info to him, published 11 Dec 2018. He cut to the chase for me, saying that my HbA1C would go up a bit, my hepatic glucose output might increase, but it was my choice. He told me I could just stop (my eyebrows went up "Cold turkey?"). Yep. This I'll discuss with my GP Doc.
My third question was "What, in your opinion, causes insulin resistance?", and I finally got him amused, because that is the $$Bajillion$$ question. He said if he knew that, we'd all be wealthy and better off. He ran thru the usual list of suspects (genes, metabolic dysfunction at the cellular level), but no one knew for sure. I took the time to lecture about Dr. Jason Fung and his clinical work, overfeeding, and hyperinsulinemia. Full circle.
So, my takeaways from the time:
- He's OK by me, and I'll see him again in 3 months.
- I worked my "disabled and intellectually challenged capabilities" joke in ("I suffer from being neither blind nor stupid."), and got him to laugh.
- I got all my this-time questions asked, discussed, and answered. I have more, for next time.
- Lastly, I need a new scale. All my recent readings have mine on the low side, so my metrology experience tells me, replace my scale. Should be here on Friday. Thanks Amazon !! this scale
My plan going forward:
- Be prepared for new scale to upset my progress apple cart, among other things.
- Press harder on my calorie intake. Lose more weight. I need to get to about 170 pounds, and not lose muscle mass.
- My next round of blood lab work will include lipids, and I expect that to be problematic, maybe. More homework.
I have a great hobby !! Thanks for listening.
Comments