Saturday, May 28, 2016

Fire, Water, and Gold

I'm a little bit absent-minded. Well, OK, I'm very absent-minded. That means that sometimes when I plan to take something with me when I go to get groceries, I forget. I live in a rural area, where the closest supermarket is about 20 miles away, so it's a big time waster if I have to go back and get the library book I went to the library to return.

The worst was when I drove to Boston without my purse. That was scary. What would happen if I ran out of gas or had an accident? Luckily, the reason I forgot the purse was that I was delivering a box of lamb to a friend, and when you have one thing in your arms you tend to forget others. The friend paid for the lamb with cash. Phew.

But when you have diabetes, you have to remember more things than library books, and when you're traveling far from home, forgetting medications or testing supplies can cause big problems. These are more serious if you have type 1 diabetes or insulin-dependent type 2. If you're out of the country it can be difficult to get replacements.

I once went to Vancouver and was so focussed on packing insulin so it would stay cool and get through customs that I forgot all my oral drugs. Obviously, my control wasn't as good as usual, but unlike someone with type 1 who forgot insulin, I didn't end up in the ER with diabetic ketoacidosis. Still, it was not a good experience.

I mentioned my absent-mindedness to a friend who had been a pilot in the RAF, and  he suggested that I do what pilots do: run through a list of things to check before I leave the house. Good idea.

So I came up with Fire, Water, and Gold. Fire means to check the woodstove to make sure I haven't left the damper open. I also make sure I haven't left a pot on the stove. In the summer I substitue Ice for Fire, which means to put ice in a cooler I keep in the car in case I buy frozen food. Water means to make sure the water isn't running. My water collects up the hill and runs down by gravity, and if it runs too long, it drains the holding tank, which loses the siphon, and I have to pump it back up the hill to get the siphon going again. Gold is my purse.

With time I found I was sometimes forgetting to take my meds before leaving for something that took the whole day, so I changed to Fire, Water, and Gold Pills. Then I added "Plus 2" to remind me to disconnect two computers if there was any chance of a thunderstorm. Fire, Water, and Gold Pills Plus 2. At one point there was also a Plus New and Plus Blue but they weren't essential and now I can't even remember what they were.

This mantra is so simple that even I can remember it, and it's saved me many a time. My list obviously wouldn't work for everyone,  but if you're also a tad absent-minded and you have medications or testing supplies you really shouldn't be without when leaving home, for a trip or just for a daylong expedition,
you can come up with your own mantra. Besides, choosing something memorable is fun.

Friday, May 20, 2016

New Hormone Involved in Blood Glucose Control Discovered

New hormones are always being discovered, and the latest, called asprosin, is related to blood glucose control and insulin levels.

When blood glucose (BG) levels fall, for instance during the night, white adipose tissue (fat) releases asprosin, which increases BG levels. The increased BG levels then trigger the release of insulin, so BG levels don't get too high. That's how it's supposed to work.

But people with a rare disease called neonatal progeroid syndrome (NPS) that means they can't store fat can't produce asprosin because they have no fat. They can't use fat as an energy source between meals, because they don't have any, and hence they have to eat carbohydrates all day and even wake up during the night to eat to make sure their BG levels don't go too low. Without fat they don't have this trigger to keep BG levels up when they're not eating.

NPS patients can eat all the carbs they want without gaining weight, which might sound wonderful to anyone with a weight problem. It's not.  The woman in this article has never weighed more than 64 pounds, and cruel people make fun of her appearance. She says she has to eat constantly to keep her energy levels up.

Scientists discovered asprosin (which got its name from the Greek word for "white" because it's produced in white fat) by studying two people with NPS. Trying to find out what caused the disorder, the researchers did DNA sequencing of the NPS patients and discovered the new hormone.Then they figured out what it did.

Lipodystrophy (loss of fat tissue) is often associated with insulin resistance, so the researchers expected that the NPS patients would have elevated insulin levels. But they found that the NPS patients had two-fold lower insulin levels than normal. That's because they couldn't produce asprosin, which increases BG levels, which increases insulin levels.

Then they found that asprosin levels were doubled in obese insulin resistant men. Thus they wondered if blocking the action of asprosin could help control metabolic syndrome and type 2 diabetes. Indeed, in mice, an antibody against asprosin does reduce both glucose and insulin levels.

Of course we all know that what works in mice doesn't always work in humans. So only time will tell if this discovery has practical application. But it does sound promising. It also shows how complex the regulation of BG and insulin levels are, and different people with metabolic syndrome or type 2 diabetes may have defects in different systems. Thus it's not surprising that there's no one-size-all solution to these disorders.

Saturday, May 7, 2016

Maintaining Weight

Many of us gain weight as we age, but some people seem to stay at the same weight for most of their adult lives. How do they do it?

A pound of fat contains 3500 calories, and dietitians and are fond of telling us that if we eat an extra 3500 calories a year, we’ll gain 1 pound a year, so we’ll gain 10 pounds a decade and 50 pounds between high school and retirement age and that this partly explains the “obesity epidemic.” The idea is that just overeating by a tiny bit will result in significant weight gain in the long run.

But that 1 pound a year works out to about an extra 10 calories a day.

Now, we all know that the body/brain does miraculous things, but it’s never made any sense to me that our bodies, and especially our brains, would be able to control our food intake so closely that we would eat within 10 calories of what we needed. A stick of chewing gum contains about 10 calories.

So I was interested to read a recent article about male Barbary macaques. It seems that these monkeys regulate the amount of thyroid hormone they produce during mating season, when they need extra energy to fight with other males as well as mating with as many females as they can.

Some monkeys actually double their levels of thyroid hormone at the peak of the mating season. Extra thyroid hormone would speed up their metabolism, burning more food instead of storing it, which would provide more energy during this stressful season. Conversely, when food is scarce, they produce less thyroid, slowing their metabolism down. This is analogous to what some humans find when they eat a lot less in order to lose weight.

Of course, this might make one think that if you're overweight, all you have to do is take a little thyroid hormone and your weight will melt away. Unfortunately, that doesn't work unless you start out deficient in thyroid hormone, and too much can be dangerous.

However, it suggests to me that the body could compensate for a little overeating or a little undereating by simply increasing or decreasing the amount of active thyroid hormone in the bloodstream to keep our weight constant. Massive overeating or undereating would still have massive consequences for weight. But that extra stick of gum every day would not make us obese.