Diabetics and Statin Drugs

I recently read this blog post by Michael Aviad about his experience with doctors and the perspective that statins are crucial to reducing cardiac risk in diabetic patients. I commented on it as concisely as I could, but I think I'll expand on it here.

My doctor recommended that I take statins last summer because my Total Cholesterol was above the acceptable range for a diabetic. It was fine for a non-diabetic.
Why do diabetics have a lower ideal number than non-diabetics? Risk factors... Because, generally, diabetics tend to have higher triglycerides and higher A1Cs than normal people, which also carry a greater cardiac risk profile. Abnormal A1Cs typically correlate with high LDL counts.

I did some research about statins and found a couple of facts about the relationship of all these things to each other and came to some conclusions.

• Statins are anti-inflammatory, which can reduce risk for inflammatory health problems, like heart disease. Some experts even say that the benefits of statins might be more from the anti-inflammatory characteristics than the cholesterol lowering effects. 
• High blood sugar is inflammatory, which is a risk factor for inflammatory health problems. 
• Insulin also inflammatory. Insulin resistance is a sign of hormonal imbalance and inflammation.
• Eating low-carb reduces the need for insulin and increases insulin sensitivity. Needing smaller amounts overall helps achieve tighter glucose control (Dr. Bernstein's "rule of small numbers".

You could say that they kind of cancel each other out. But... if you can manage to keep your blood sugar normal... then you have activated an anti-inflammatory change and improved your risk. I chose to aim for that, and skip statins. Plus, research has shown that if you lower your A1C score, your LDL count will often descend with it. I'd rather work with something I've had 26 years practice with. Sounds like good glucose control is the winner all around. I'm not saying it's easy, but, it's possible.

Also, about LDL cholesterol. There is a correlation between LDL cholesterol and triglycerides. If you have high triglycerides (from eating a lot of carbs and sugar) then your LDL particles are likely to be dense and be plaque forming. If your triglycerides are low, then your LDL particles are more likely to be large fluffy particles that resist forming arterial plaques. Your LDL isn't considered dangerous if you also have low triglyceride numbers.

As a low carb eater my triglycerides are very low. My A1C is getting closer and closer to normal, non-diabetic numbers. With these two arguments, I told my doctor that I wasn't going to take the statins and risk their side-effects. He agreed with my choice. Another doctor, on the floor at the hospital in December, tried to put me on statins without even meeting me, and I also refused that offer.

I'm much more interested in discipline and knowledge than in a preventative drug.  I think we have the information to make wise individual decisions for ourselves in this matter. Look at all the facts, and check out all the opinions. I don't consider myself to be the average diabetic or statistic. So the collective opinion of doctors created for the average statistic, isn't necessarily a good fit for me.

Graphing inertia

I've noticed that when I have good results for a stretch, it keeps going that way pretty smoothly until I make a mistake, or get cocky or careless and mess it up. Then, it goes poorly for a few days until I dial it in, stop making mistakes and get it back in line.

It seems like if I let my glucose go high for one event, my average need for insulin, and average glucose level will rise for a day or more afterwards. It's like high glucose creates insulin resistance and prolonged poor control.
When things go well, it feels like my body really gets tuned in and then it will stay that way pretty well, even lowering it's need for insulin progressively, and then if I expose myself to high glucose for a day the effect seems to linger and change my metabolism and insulin demands for a while.

This kind of thing makes it difficult to get good control, because it's a slow process of bringing things back into line, and you can't assume anything about normal basal rates and correction doses. It just doesn't work the same until I get everything ironed out again.

Does anyone else see these types of trends?

Additional note:
15 min. Exercise correction
5:20pm 101mg/dl
6:00 dinner & bolus
7:00pm 141 mg/ dl
8:00pm 169 mg/dl (and rising) elliptical 15 minutes
8:15pm 114 mg/dl
10:45pm 90 mg/dl stable

(exposure to abnormal glucose levels- less than 2 hours)

What's worse?

I don't know what's worse... going around without a sensor and neurotically wondering where my glucose is headed, or having a sensor that is inaccurate for it's entire life. It's kind of like the difference between flying blind, and being teamed up with someone you can't depend on...

This week I've had one that has been wrong the whole time. Normally, I give them a couple days grace to get fully calibrated, and then enjoy 5 days of spot-on, predictable accuracy. So far, this one is a dog. As much as I dislike the harpoon-like nature of putting a new sensor in place, it's probably time to end it early and move on to one that works.

I'm happy for the 8 out of 10 sensors that give me great information. It only makes me more aware of my dependency when one doesn't work right. 

At least my meter is dependable... I think.

Discoveries...

Everything that I have found out about diabetes "on my own", was also told to me by someone else a long time ago, and I just didn't grasp it. As I read through books (that I've read before), I'm finding relevant information that reinforces all the "new" knowledge. I guess, I've probably been exposed to a lot of good stuff, I just need the right moment or a 2nd or 3rd go around to "get it".
Diabetics, if you want to make your lives better, go find the info, it's out there. I can vouch for that.

Non-diabetic glucose levels... also a wild ride.

We were driving home from church today and Carol said she was feeling hungry, and like her blood sugar just dropped. A bad feeling. I offered to check her blood sugar in the car, and she was game. She was 142 mg/dl, and I was kind of alarmed. I tested it again, and made sure there was nothing on her finger (142 also). I know that non-diabetics aren't really supposed to hang out in the 140s. And, it wasn't just after a large, carby meal. She had nibbled a couple pretzels at church and was holding out for real food at home. We had some fun joking with the kids about the implications of having two diabetic parents. I hope you guys enjoyed that pizza last night, because it's over!

When we got home I ran an at home A1C test on Carol she read 5.2 (an average BG of 104). Since I'm not used to thinking about non-diabetic numbers, I wasn't sure if it was totally normal or not. I just knew it was a number I'd love for my own... as it turns out, it's pretty normal. Could be lower, but not considered pre-diabetic or anything.

Next, the kids all wanted to be checked.
Ellie (13), was 111 mg/dl. She had just finished eating some ice cream.
Simon (11) was 85 mg/dl.  Pre-lunch for him. He eats low-carb like me. From what I understand, this is the ultimate "normal" reading.
Penny (7) was 141 mg/dl. Fruit snacks at church. They say that young kids have a higher normal range. She's still young (her first test read 217, but after washing her hands it was more reasonable).

Carol tested again, and it was back down to 93 mg/dl. She had eaten a sandwich and felt better.
Tonight we did another test at about 9pm and she was 94 mg/dl. 

I thought it was funny that Carol's sensation that she had "low" blood sugar had prompted this test fest. It was a bit of a role reversal. I think I was the only one that didn't get tested that hour. I have to say, it was kind of fun to share my pastime with the family.

One more note, while my brother, Dave, was visiting last summer he said that after a large meal and a beer he totally crashes, and he said he thought it was because his blood sugar was going high. I was curious, so we tested after a feast + brew. Surprisingly, his glucose was only 110 mg/dl. It just goes to show that non-diabetics have darn good control, but feel all the icky fluctuations of the sugar and insulin roller coaster. You could say it just never really goes off the rails, just feels like it...

Insulin Action Acceleration

The larger a dose of insulin is, the faster it does it's work. Since I take fairly small doses of insulin, boluses are usually around 2-3 units or less, I hardly ever see my sensor with arrows showing that I'm trending down or up. In general, it's good to have changes in glucose happen more gradually, but when you are really out of range, you want faster change.

The one thing that has allowed me to experience rapid changes in blood glucose lately is exercise. I know I've already talked about it, but having a sensor to look at during every experiment has taught me a lot. If I get on the elliptical for even 10 minutes I will soon see an arrow showing a rapid change in my blood sugar. Often, it will be a double arrow, indicating that I'm dropping faster than 5 mg/dl per 5 min. I know that exercise makes you more sensitive to insulin (needing less), but this is clearly also an accelerated absorption rate. If I have a 2 units of insulin in my system and the rate of change is so slow that my sensor graph is barely showing it... 10 minutes of low-level activity will turn the insulin receptors on and have me in a fast correction. I'm finding that it allows me to spend less time out of range, when I make a mistake.

Here's an example from yesterday:
I was going into lunch feeling hypo and my sensor was reading 80. I decided to eat the baked potato that came with my ribs, as a precaution. Since I'm very sensitive to fast-acting carbs (plus, I generally underestimate them), I ended up at 275 mg/dl later in the day. I took a correction bolus, but didn't see much change. About an hour before dinner I got on the elliptical for 15 minutes. My blood sugar began dropping (double-down arrows) and dropped all the way through dinner. By 7pm I was using glucose tabs to keep myself in range. Overall, I didn't take that much insulin, but with exercise, I could have probably taken half as much for correction (and with dinner), and still gotten it fixed in 2 hours.

 In the future, I'll have to be more conservative with correction doses if I am going to use exercise alongside. And, because of the immediacy... I definitely will.

When I first started really focusing on my glucose control in 2003, I spent most of my energy on managing my food intake and insulin. I felt that exercise was just a monkey wrench that would make things more unpredictable. Now that I am tinkering with this, I feel like I just discovered the other 30% of my toolbox. Ironically, I'm spending less time exercising than ever, a little bit seems to be more effective than an hour, so it's much easier to find time for it.

Just a number... yes, I share.

I am doing at home A1C tests every month to see if it jibes with my sensor average. This month it came in at 6.1, which indicates an average glucose of 128 mg/dl for the past 3 months. It's heavily weighted on the last month, but also shows a longer reaching trend. It's my best (likely valid) result that I've had in my diabetic life. I'm happy about it. During the past year I have tested between 7.8 and 6.7 (which translates to averages of 177-146 mg/dl). My goal this year is to get into the 5s.