As I prepare to leave the beautiful
city of Bogotá, after 3 weeks of studying Spanish, a few thoughts related to
T2DM come to mind. This is a burgeoning city, growing leaps and bounds,
transitioning from “a feudal society” (to quote the husband of my teacher) to a
modern, invigorating, stimulating place. I loved it, and it’s exciting to see
the changes coming about, but also shocking to see the stark contrasts. For
grounding and perspective, the husband reminded me that women only gained the
right to vote in 1957.
For me personally the most
surprising discovery was that the brand new, modern apartment I rented, that
has multiple USB connections in the kitchen and bedroom, has no central heat!
Further, there is no hot water in the kitchen – only in the bathroom, with an
electric in-line hot water heater for the sink and shower.
At first, I thought that this was a
factor of the neighborhood (services are taxed by “estrado”). This method of
taxing services by socio-economic status is designed to give preference
(“subsidies”) to the less advantaged. Unfortunately, it also results in
stagnation and immobility by stigmatizing the poorer neighborhoods.
Later, I discovered that the modern,
well-designed apartment of my teacher and her husband (both PhD’s teaching at
the National University) also has no central heating and no hot water in the kitchen. ¡Qué sorpresa! They live in an upscale
neighborhood in the northern reaches of the city. The “no heat” explanation
relates in part to the climate. Bogotá has a moderate climate year round. It is
located close to the equator but at a very high elevation (8,675 feet or 2,644
meters), so temperatures are constant all year round. It never snows.
So this partially explains the
central heating issue, but not the lack of kitchen hot water. “How do you wash
dishes,” I asked the husband as he did them. “I scrub them well,” he said. Does that give you perspective?
Type 2 diabetes is similarly just emerging
from the dark ages. One hundred and fifty years ago type 2 diabetes was
understood as a dietary disease (see my #1 with reference to Claude Bernard and William Banting). It was known as a
disease of excessive consumption of carbohydrates and was treated by reducing
carbohydrates in the diet. Then, in 1921, Frederick
Banting (bizarrely, a distant relation!) discovered how to make insulin in the
laboratory, and since then type 2 diabetes has been treated like type 1
diabetes, a disease of too little
insulin.
When our insulin receptor cells
resist the uptake of glucose, i.e. they express Insulin Resistance (IR), the
pancreas produces more and more insulin until it eventually wears out. Doctors
hasten this catastrophic failure of the pancreas by adding pharmaceuticals,
like sulphonyureas (Micronase, glyburide, glipizide, et al.) to push the
pancreas to exhaustion. Then, the doctors add injected insulin to the patient’s
regimen. This medieval practice, not
unlike “bleeding the patient,” is still the standard of treatment of the
medical and government overseers in the United States.
But we are finally entering a
Renaissance. Increasingly type 2 diabetes is being understood again as a
disease of Insulin Resistance, resulting in too
much insulin. The goal in treating type 2 diabetes should be not only to
lower the glucose level in the blood (by
diet instead of drugs), but also to lower
the insulin level in the blood.
This will occur, and will only occur, when the glucose level
lowers, because that is how the body “knows” that it needs to begin to burn fat
(our triglycerides, in the form of body fat stored around the “trunk,” to
maintain energy balance and a fully active metabolism. The body, including
heart and brain, loves these fatty acids and the ketone bodies that are
produced as a side effect of lipolysis (the catabolism of triglycerides to
fatty acids).
And, for anyone interested, this is
also best way to LOSE WEIGHT, easily and without ever feeling hungry.
Bogotá is rapidly
transforming itself. ¡Ojalá que el mundo de los diabéticos se haga lo
mismo! Y pronto.
No comments:
Post a Comment