Monday, January 29, 2007


Dawn Phenomenon and Somogyi Effect

A very puzzling aspect of diabetes is the contradiction in everything. Glucose levels can bounce around and there doesn't seem to be a clear cut semblance of rhyme and reason to it all. Some people experience weight gain. Some drop pounds. I fit into that category. Sometimes, I'm satisfied with the food I eat. Other times, I cannot satiate my appetite, no matter how much I eat. I have to be very careful with that, too, not just with the types of foods I consume.

A friend of mine works for a bookstore in Winter Park, Florida, called Bargain Books. It was very nice and extremely appreciated when John gave me two books, Diabetes for Dummies and Cholesterol for Dummies. You can't beat good, caring souls. As I was leafing through the diabetes book, I stumbled upon Dawn Phenomenon in the glossary of terms and decided to explore it online. I have this problem and I know many other diabetics do, too.

My blood glucose level is always higher in the morning than it is at night. Why? It doesn't make any sense that an empty stomach level would be higher. My mother has always said that it's a mystery what diabetes does and how the body reacts to it. Everything can flipflop around and doctors don't always seem to have the answers. My father has maintained that what you ate the day before can have that sort of effect on you the next day. Sounds reasonable enough, but then I stumbled upon that phrase. Everyone experiences Dawn Phenomenon, whether diabetic or not. We all have a biological clock. Technically, this one is referred to as Circadian Rhythms and it is rather simple to explain. Your body uses carbohydrates, protein and fat to store energy and during sleep, you use that stored energy to help keep your chemicals balanced. These "macro-nutrients" are converted to glucose stored in the liver and muscles.

Overnight, your body releases some hormones. They come in the form of Growth Hormones from the anterior pituitary gland, cortisol from the adrenal cortex, glucagon from the pancreatic alpha-cells, and epinephrine, otherwise known as adrenalin. These hormones trigger an increase in insulin resistance and add stored or new glucose to your bloodstream. All of this adds up to higher blood glucose levels and a diabetic can have real problems with it.

This activity normally occurs during the hours from 4am - 11am and explains why my sugar is higher in the morning, but what can be done to resolve it? There are different ways to bring that overnight level down and everyone must experiment on their own. One method is to eat a light snack with a slow digesting fat and protein content, such as peanut butter or deli meats and cheeses. The theory is that it holds your blood glucose level high enough overnight to avoid the problem. Some people eat a green apple, such as a Granny Smith or take vinegar supplements to ward off Dawn Phenomenon or Somogyi Effect, which I will try to explain next. Try eating breakfast when you first get up and test your sugar later. There are different things which may or may not work for you. This is not a disease that has any uniformity to it.

Somogyi Effect is often referred to as Liver Dump and usually occurs in insulin-using diabetics and those who go hypoglycemic during the night. When your glucose level drops too low, the liver kicks in and does its best to stimulate and release glucose. One way to try to determine whether you have Dawn Phenomenon or Somogyi Effect is to test your glucose between 2am - 3am several nights in a row without snacking before you retire. If you test normal, it's likely Dawn Phenomenon. If you test low, it could be Somogyi Effect and setting your target number a little higher before you go to bed may eliminate the problem.

I'm going to try the peanut butter (or cheese) snack before I enter the realm of Sleeptown and see if that helps reduce my glucose in the morning. I've been running around 150-160. If that doesn't help, I might have a small (2 ounce) glass of red wine and see what happens. Alcohol lowers blood glucose and it may do the same thing as eating an apple or taking vinegar pills. Who knows? Like I said, it's a very contradicting disease and it could be either Dawn Phenomenon or Somogyi Effect. Certainly, I will talk it over with a doctor, next time I see one.

Wednesday, January 24, 2007


Most people don't understand diabetes. There are plenty of misconceptions out there. Fortunately, I had been researching it for years before I got the disease because my mother has had it for a long time. Of course, there's still plenty for me to learn. I seriously doubt anyone who has it will ever quite fully understand what are the right and wrong ways to deal with it. For example, some things may effect you one day and not the next. Why? Who knows. I am going to try to explain some of the areas that I get questioned on by my friends.

Before I knew I had it, I had been feeling below par for some time. When I realized what I had and was officially diagnosed by a medical professional, it explained why I had mood swings and why I was rather irritable at times. Normally, I've never had much of a temper. One always wants to believe they are healthy and to find out about this can bring you into an emotional quagmire, which I did kind of fall into. It became almost an obsession for the first month and that seemed to be the topic of most of my conversations. Some of my friends started to drift away in fear that, uh-oh, here comes Diabetes Dave again. I noticed it, too, and began to realize I needed to get on with my life. Granted, it can snowball on you. I wasn't feeling well at all and that was compounded by my fear. I believe the blood pressure, diabetes and cholesterol medications have helped me tremendously. My blood glucose levels have come down and I don't feel nearly as achy and weak as I used to. Mentally, I have adjusted as well. I no longer think my life will be cut short. Most people can live long lives as long as they maintain a proper regimen of diet, exercise and monitoring sugar and lipid levels regularly.

One fallacy is that we must give up many of the foods we've always enjoyed eating. Everyone thinks we cannot eat sugar. With proper drugs, there is no reason to stop eating all sugar. Certainly, I'm not going to play a game of Russian Roulette with myself by buying candy and other junk none of us should really eat to begin with. Where I used to do that, instead I eat an orange or an apple. This way, I get natural sugar and nutrition, to boot. Carbohydrates are the real culprit. They raise blood glucose levels. That means a big plate of spaghetti is no longer an option. Neither are many breads, particularly those made with bleached flour. Rice, potatoes, corn and other starchy foods should be kept to a minimum. Instead of eating a plate full of mashed potatoes, I eat less than a quarter. We need good carbs at each meal. Some say to curb fruit and bean consumption because of it, but my first doctor told me I could eat all the fruits and vegetables I want. Beans, too. Eating a diet in carbohydrate-rich foods with low glycemic indices like fruits, beans and oatmeal may reduce the odds of someone getting diabetes. This also has the added benefit of increasing your vitamin, mineral and fiber intake. Protein is very important with each meal. Now, every time I go to the grocery store, I carefully examine the nutritional facts for fat, cholesterol, sugar and sodium content. It's a pain, yes, because many of the things I would like to eat are somewhat suspect. Once in a while, I'll treat myself.

Not all diabetics are on insulin. I'm not. I take a pill. Type 2, or adult onset, means that your pancreas isn't producing as much insulin as it should to properly process sugar in your body. That's where energy comes from. It could also mean that your organs aren't doing the job with the insulin, too. It might be a combination of the two. In type 1 diabetics, the pancreas produces no insulin and the only way to get it is through injections. Ironically, type 2 can eventually turn into type 1 as the pancreas stops producing altogether, but never the other way around. That is the fate a lot of diabetics face and it's not because you're not taking care of yourself, it's just the nature of the disease. It is progressive.

Exercise is of the utmost importance. If you remain a couch potato, your heart, kidneys, liver, eyes and nervous system will begin to fail. I try to park far away from a store so I am forced to walk a greater distance. Every little bit helps.

You don't have to be obese to be a diabetic. I'm certainly not and never was. As a matter of fact, I lost a lot of weight because of it. The most I've ever weighed was 205. I settled in at around 185 for many years. The other morning, I weighed myself. 158. All my friends are really noticing it now. I don't want to lose any more!

Diabetes is brought on by many factors. It could be from a poor diet, especially what's in processed foods today. New York City recently passed a law banning trans fats in all restaurants. Now I know why. You want to increase your chances of getting it? Keep eating those Twinkies. If you ever have felt that smooth grease on the roof of your mouth while eating something tasty, that's the trans fats in action. Remember, trans fats have a higher melting temperature than your body. That means every time you eat something containing it, it solidifies in your system and starts to go to work clogging your arteries and doing other nasty deeds. Long ago, the government gave hydrogenated and partially hydrogenated oils the green light, assuming it was a healthy alternative to the saturated animal fats in other products, like butter. They were wrong. Avoid trans fats at all costs! Studies have shown that vegetarians have a much lower risk of getting diabetes type 2. Lack of exercise will also contribute to greater risks of getting sick. I can attest to that. Remember that genetics play a giant role in acquiring diabetes. If someone in your family has it, there's a good chance you will, too, especially if you don't take care of yourself. Age also increases the risk. People over 45 are more susceptible and the odds go up every year. American Indians, Hispanics and African-Americans are more prone to develope type 2. Everyone should get checked for high blood pressure and blood fats as they age.

Quit smoking! That is something that's weighing heavily on my mind. With every puff, I'm increasing my risks of having heart attacks and strokes. Smokers are more likely to become diabetic than are non-smokers. Alcohol is bad. For healthy people, moderate drinking lowers blood sugar and improves glucose tolerance. There are alcohols diabetics should avoid, like beer and liqueurs. Anything with carbs and sugar. Diabetics who drink are at a much higher risk for eye and nerve damage in the form of neuropathy. No more than 2 drinks a day, if any at all.

Here are some nutritional supplements to take if you have diabetes:

Alpha lipoic acid


Evening primrose oil



Always check with your primary care physician before you take any additional supplements. For one thing, there is a chance that something might interfere with other medications. I will continue to study this disease and report anything I find of interest, that I think is truly of benefit. I will not ever write something that could be questionable. I don't care what some of those quacks out there are spewing, there is no cure. It is a lot more controllable if diabetics take very good care of themselves.

Friday, January 12, 2007


If you have followed my diabetes posts, you know I am now on 3 prescription medications:

GLIPIZIDE (Glucotrol) for diabetes

LISINOPRIL (Zestril, Prinivil) for blood pressure and, mainly, to protect my kidneys from disease

LOVASTATIN (Mevacor) to lower cholesterol and triglycerides

There are some rather interesting side effects associated with these drugs. If I forget what I'm writing or wander off somewhere, I might not remember why or when I did it. If I get cranky or START YELLING AT YOU, it means I now hate everyone and I want to run you off the road. To keep it simple, these drugs also have overlapping effects, but I will only list them once. Some, I have already experienced. I'm not going to tell you which ones, though, and if you ask, I might break into tears.

• Consipation or stomach pain
• Diarrhea (are these top two just so they can cover their butts?)
• Muscle pain and tenderness
• Weakness (duh... the diabetes made me feel that way)
• Severe fatigue
• Fever
• Yellowing eyes and urine
• Dark urine
• Persistent nausea
• Dizziness
• Headache
• Lightheadedness
• Dry cough
• Blurred vision (again, the disease has alredy caused that)
• Sore throat
• Fainting
• Decreased sexual ability (I don't want to talk about it)
• Rash, itching, swelling
• Trouble breathing
• Vomiting
• Loss of appetite (I wish)
• Easy bleeding or bruising
• Unusual or sudden weight gain (I wish)
• Hypoglycemia (low blood sugar)
• Confusion
• Mental/mood changes
• Chest pain
• Uneven heartbeats
• And, in very rare cases - suicide

In each case, there is a statement that says, "Remember that your doctor has prescribed this medication because the benefit to you is greater than the risk of side effects." I'm trying to explore macrobiotic options. One of the most important thiNs abot tHs florBl gogN roofn jmpofflin gor

Wednesday, January 10, 2007


Last Thursday, I went to Quest Diagnotics to have blood drawn for a lipid panel and a serum glucose test. I also peed in a cup for a microalbumin/creatine ratio. Last night, I went to Shepherd's Hope for my final visit to receive the results of those tests.

For the past month or so I have made a concerted effort to alter my diet. For breakfast, I generally eat a veggie burger, an apple and a banana. The burger is not consumed as a substitute for meat. It is a source of protein, which diabetics must have at every meal, and it is easily heated up in a microwave oven. Very convenient. For lunch, I eat a mixed greens salad with fake lobster for protein. Fake crab is often referred to as "krab." I wonder what artificial lobster should be called? Lovster? I am a little more lax around dinner time, but I try not to venture outside of my dietetic parameters. I have been on Glipizide for a month now. I started to take chromium picolinate and magnesium. Of course, I'm taking Lisinopril for blood pressure to protect my kidneys. My blood glucose levels have fallen dramatically. Where I used to range from over 200-400 per day, my levels generally range between around 100-150. That is a very good thing. Remember, normal is 65-99. Interestingly, and in spite of my change in eating habits, my triglicerides went from 190 to 222 from my previous test a month or so ago. Normal is 150 or less. My total cholesterol remained about the same, 213 to 216. It should be less than 200. My HDL (good) cholesterol dropped from 41 to 37. My LDL (bad) remained about the same at 135. The normal number should be less than 130, but for diabetics, it should be below 100. The urine test was done to determine the shape of my liver. No problems there. Less than 30 is the ideal. Mine is 16. The serum glucose test is the same as what I take twice daily when I prick my finger. The first test was 182. Thursday it was 143. That is the fasting number and it must come down.

One thing I have noticed of importance is the way I feel. My strength is returning. Where, on most days I felt achy and weak, I am now the other way around. I'm not ever quite 100%, but clearly a whole lot better.

On my last visit to the clinic, I had the cold and abrupt Dr. Chan who insisted I didn't need Lisinopril. This time, I asked the attending nurse if I could see a different doctor because of what my pharmacist told me about the benefits of that drug in diabetes and that Dr. Chan would not write a new prescription. I got to see Dr. Velez.

Dr. Velez, it turns out, happens to be a diabetic. I found this out incidentally. I mentioned the Lisinopril and what Dr. Chan had told me. That's not really true, he said. I told him that my mother is diabetic and when she went to see her endocrinologist last week, she took my first test results with her. I wrote down the drugs and supplements I was taking. The drugs were fine and the chromium may help reduce sugar a few percentage points, he told her. Dr. Velez asked me who her endocrinologist is and I told him. "He's my doctor, too!" he responded.

Dr. Velez is a very kind and caring doctor. He is also aware of the benefits of chromium picolinate and magnesium. I asked him if they were absolutely safe to take and he responded positively. I asked him about cinnamon and he said he had never heard about that one. I told him my father's doctor told him it was good for the disease. Well, you can't expect every doctor to know everything about every drug and supplement, but I'm sure he'll look into it. I asked him if I would need to go on a cholesterol medication. Yup. No doubt about it. Mevacor 40mg. Knowing that this would be my final visit there and I would, henceforth, have to fend for myself, he wrote me 3 prescriptions, all for 90 day supplies. Through this clinic, for 90 days, I will save a lot of money on the Mevacor. It will cost me $7 per month for the first three months at the Central Florida Pharmacy Co-op. I checked with my pharmacy and their price is $65 for a 30 day supply. Big difference. $21 as opposed to $195. He also scheduled me for more tests to be done in April at the clinic's expense. This will also save me a tremendous amount of money and will include a Comprehensive Metabolic Panel, a Lipid Panel and a Hemoglobin A1C test. By then, I will have already established myself with a primary care physician who would make me take those same tests at my expense.

I really want to thank the dedicated volunteers at Shepherd's Hope for all they have done for me and the many others without health insurance. If not for them, where would I be today? I especially want to thank the doctor I spoke with last night, Dr. Carlos Velez-Munich, who would be my primary care physician if I had health insurance or could otherwise afford all that diabetes entails. He is a very good man.

If you have it in your heart, please contribute to Shepherd's Hope or any type of similar clinic that is there to help those in need who might not be able to afford quality care. They are out there. All I did was Google "free orlando clinics" and up it popped.