What You Can Expect from
Virtually Normal Blood Sugars
Richard K. Bernstein, M.D.,
F.A.C.E., F.A.C.N., C.W.S.
I
am convinced, from my personal experience, from the experiences of
my patients, and from reading the scientific literature, that people
with normal blood sugars do not develop the long-term complications
of diabetes. I am further convinced that diabetics with slightly
elevated blood glucose profiles may eventually develop some of the
long-term complications of diabetes, but they will develop more
slowly and likely be less severe. In this feature, I will try to
describe some of the changes that I and other physicians have
observed when the blood sugars of our patients dramatically
improve.
MENTAL
CHANGES
Most
common, perhaps, is the feeling of being more alert, and no longer
chronically tired. Many people who “feel perfectly fine” before
their blood sugars are normalized comment later that they had no
idea they could feel so much better.
Another common occurrence relates to
short-term memory. Very frequently patients or spouses will refer
to their “terrible memory.” When I first began my medical
practice, I would ask patients to phone me at night with their
blood sugar data for fine-tuning of medications. My wife, a
physician specializing in psychoanalytic medicine, sometimes
overheard my end of the conversation and would comment, “That
person has a dementia.” Weeks later, she would again hear my end
of a conversation with the same individual, and would comment on
the great improvement of short-term memory. This became so common
that I introduced an objective test for short-term memory into the
neurologic exam that I perform on all new patients. About half
my new patients indeed display this mild form of dementia, which
appears to lift after several weeks of improved blood sugar. The
improvement is usually quite apparent to spouses.
DIABETIC
NEUROPATHIES
Diabetic
neuropathies seem to improve in two phases a rapid partial
improvement that may occur within weeks, followed by sustained
very slow improvement that goes on for years if blood sugars
continue to remain normal. This is most apparent with numbness
or pain in the toes. Some people will even comment, “I know
right away if my blood sugar is high, because my toes feel numb
again.” On the other hand, several patients with total numbness
of their feet have complained of severe pain after several months
of near normal blood sugars. This continues for a number of months
and eventually resolves as sensation returns. It is as if nerves
generate pain signals while they heal or “sprout?’ The experience
may be very frightening and distressing, especially if you
haven’t been warned that it might occur.
Erectile
impotence affects about 65% of diabetic males, and is the result
of years of elevated blood sugars. It may be defined as an
inability to maintain a rigid enough penile erection for adequate
time to perform intercourse. It usually results from neuropathy,
blocked blood vessels, or both. We can perform simple tests to
determine which of these causes predominates. When the problem is
principally neurologic, I frequently hear the comment, sometimes
after only a few weeks of near-normal blood sugar profiles,
“Hey, I’m able to have intercourse again!” Unfortunately,
this turnaround only appears to occur if the man was able to
attain at least partial erections before. If at the original
interview, I’m told, “Doc, it’s been dead for years; I
know recovery is unlikely to occur. If testing shows that the
problem was due primarily to blocked blood vessels, I never see
improvement. Note, however, that it’s normal to be unable to
have erections when blood sugars are too low, say below 75 mg/dl.
Another
remarkable change relates to autonomic neuropathy and associated
gastroparesis. I have documented major improvement of R-R interval
studies in many patients, and total normalization in a few. Along
with this, we see reduction in symptoms of gastroparesis. Usually
such improvement takes place over a period of years. Although it
occurs most dramatically in younger people, I’ve also seen it
occur in seventy-year-olds.
VISION
IMPROVEMENTS
Diplopia,
or double vision, is caused by neuropathy of the nerves that
activate the muscles that move the eyes. It is a very common
finding on physical examination, but rarely severe enough to be
noticed by patients on a day-to-day basis. Here, again, when
testing is redone after a few years, we find improvement or even
total cures with blood sugar improvement.
Vacuoles are tiny bubbles in
the lens of the eye. They are thought to be precursors of
cataracts. I have seen a number of these vanish after a year or
two of improved blood sugars. I have even seen the disappearance
of small spokes on the lens that signify very early cataracts.
I’ve seen cases of glaucoma
cured by normalization of blood sugars.
OTHER
IMPROVEMENTS
Improvements
in risk factors for heart disease, such as mild hypertension,
HDL-cholesterol ratios, triglycerides, and fibrinogen levels, are
commonplace. They usually can be observed after about two months.
Similarly, improvements in
early changes noted on renal risk profiles are often obtained,
usually after one or two years, but sometimes after a few months.
Most dramatic and commonplace
is the feeling of satisfaction and control that nearly everyone
experiences when they produce normal blood sugar profiles, HgbA1c
between 4.2 and 4.6%. This is especially true for individuals who
had already been taking insulin, but appears also to occur in
those who do not take insulin.
Last but not least is the
feeling that we are not doomed to share the fate of others we have
known, who died prematurely after years of disabling or painful
diabetic complications. We come to realize that with the ability
to control our blood sugars comes the ability to prevent the
consequences of high blood sugars.
I
have long maintained that diabetics are entitled to the same blood
sugars as nondiabetics. But it is up to us to see that we
achieve this goal.
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The
above was abstracted from Dr. Bernstein’s book “Diabetes
Solution”.
To
view other advice from Dr. Bernstein go to www.diabetesincontrol.com/bernsteinarchive.htm
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