The Once and Future Type 2 Diabetic

by Henry Gasko
(Wallan, Victoria, Australia)

Hi,

I am now 63 years old. I have always been reasonably fit - lots of jogging while I was younger, plus bush-walking (hiking for non-Australians), cross-country skiing, squash and cycling, etc.

About 12 years ago I was diagnosed with type 2 diabetes. It was quite a shock - I was fitter than average and my weight was well within my BMI limit. My pathology readings were borderline (HbA1c of exactly 6% for those who know the disease). Nevertheless my GP put me on Metformin and advised me to beware of future complications.

I have always worked in hospital IT departments. Around this same time, I was given the opportunity to work on a research project which involved, among other things, setting up a diabetes research database and doing analysis on it. I jumped at the opportunity. I also took advantage of the University of Melbourne's medical library to read everything I could about diabetes: how the disease is inexorable and will inevitably lead to various nasty complications (kidney disease, retinopathy, nephropathy - i.e. lack of circulation in the extremities leading to tingling, numbness and possibly amputation), and that there is currently no cure.

All of this is very frightening, especially when coupled with the very graphic pictures that the public don't usually see but are a large part of a medical textbook. I immediately took what steps I could: I lost about 10 kgs (from 75 kgs - not really heavy for my height - down to 65 kgs - people asked if I had cancer or something), and increased my exercise regime.

This went on for a number of years. During that time, my HbA1c never varied - it was always just about 6%. My GP was a bit surprised - it should have been getting worse. She eventually sent me a specialist clinic which was conveniently located in the Royal Melbourne Hospital where I worked. There I was given the same standard treatment and advice for a number of years, again with no change in my condition.

But one year during my annual check up, the specialists decided that there might be something funny going on here. There had been a number of recent developments in diabetes research and treatment. Type 2 diabetes was no longer regarded as a totally monolithic disease. As well as Latent autoimmune diabetes of adults (LADA) and Maturity Onset Diabetes of the Young (MODY), there was increasing recognition of something called Gluco-kinase mutations, and the specialists thought I had it.

This basically means that my internal "thermostat" that regulates my blood glucose is set somewhat higher than normal. My glucose levels are stable, regardless of medications, exercise or diet; they are just a bit higher than normal, and in fact just on the borderline of a diagnosis of Type 2 diabetes. Unfortunately it can only be verified by a full genomic analysis, which I can't afford and which the hospital does not provide as standard treatment. So I can't be totally certain.

Today I am off all medications, and my glucose levels are still the same. But the scare of being diagnosed in the first place has remained with me. The doctors keep reminding me that I am still at risk of developing diabetes, albeit from a slightly higher base level. They are not sure if this would mean the complications would be more serious than otherwise.

So what lessons are there from all this? First, the move into medical research has been personally very rewarding - I am now doing a masters degree in data mining, looking for patterns of complications in diabetes patients based on their historical glucose readings. There is still much work to be done here, but there is an increasing recognition that treating the disease more vigorously in the early stages is beneficial in the long run.

The other main outcome for me is that the habits developed during the years of being a type 2 diabetic have stayed with me. I continue to exercise far more than most of my friends of my age, and the benefits are beginning to become very apparent.

My typical week is:

- kayaking with a group of friends every Monday for 4-6 hours
- 1.5 hour weight session at the local gym on Tuesday and Friday
- home exercise on Wednesday (I have an indoor bike and rower, plus I use a cut-down version of the Insanity sessions - very challenging but can be adapted to your own level of fitness)
- 50 km bike ride either Saturday or Sunday around our local hills, with gardening and house work on the other day of the weekend. Fortunately the weather here is conducive to this even in the winter, although some of the days in summer can be too hot for any activity.
- Thursday is a rest day (I have a part-time job that means I have to go into Melbourne that day).
- 15 - 20 minutes of yoga most days

I do watch my diet as well of course - fruits and vegetables and wholemeal everything. There is lots of debate in diabetic circles at the moment about the value the traditional food pyramid, with all those carbs on the bottom, some protein in the middle and limited fats. The problem is that carbs raise the blood glucose immediately and strongly. Protein does to a much smaller extent, and fats hardly at all.

There is a very slowly developing (and by no means full) consensus that higher fat diets for type 1 and type 2 diabetics may be a good idea, keeping in mind that there are good and bad fats, and that while fats themselves do not cause people to become "fat", there is always the danger of over-consumption because of their high calorie content compared to carbs and protein - an interesting debate with lots of room for further research. As a simple guideline, the Mediterranean diet, with lots of fish and salads and olive oil and very little red meat, has been shown to be quite healthy and still consistent with Western tastes.

My advice for any other person in my age group, or anyone interested in avoiding diabetes in their future, is simple:

- start exercising early and continuing exercising as long as you possibly can. If you have some physical problem with part of your body (hips, knees, arthritic fingers, etc), there is always an alternative. There is increasing evidence that getting and staying fit is effective in reducing the likelihood of almost every disease, from the obvious ones such as diabetes to cancer, dementia, and so on.

- use more weight training. For too many years, I was just a jogger, and I think I am now paying the price with sore hips that will eventually need replacement. These days, as well as weights, I find cycling and a good rowing machine are better alternatives

- Always watch your diet. Raw vegetables are especially important for nutrients and roughage. Your friends will kid you about it, but it is worth it in the long run.

- Always remember portion size - it is possible to put on weight eating just about anything. (I have a weakness for fruit and natural yogurt - very healthy in moderation but easy to over-indulge.)

- if you have been active all your life but are told that you have type 2 diabetes, ask to see a specialist and ask them about gluco-kinase mutations. Of course, diabetes is still possible no matter how active you are (especially with a family history), and late-onset type 1 is a possibility for anyone. But it doesn't hurt to ask.

Thanks for you very informative and motivating newsletters - keep up the great work.

Henry Gasko