I’ll start this week’s discussion with a patient story from last week. I was asked to see a young gentleman, age 33, who was hospitalized with what we refer to as diabetic ketoacidosis, which is a specific situation for diabetics, including a very high blood sugar and chemicals called ketones in the blood and urine.{{more}} On reviewing his lab tests, I noted his A1C was above 9%, meaning that not only was his blood sugar high now, but it had been high for at least 3 months before. Most of the medical team does not believe this man was taking any of his medications (or not properly) because he is repeatedly coming into the hospital with this problem. If truly he was not taking his medication as he should, he is not only doing damage to himself now, but he may also be setting himself on a path where damage is difficult to reverse. At my recent conference, they talked about a concept called “glycemic memory” which has effects on the way your body responds later on.

A few years ago one of the diabetes research studies had shown some good information about this “glycemic memory”. They had found that in people with Type 1 diabetes, if they had great control of their diabetes for the first 10 years, they did better later on even if they did not keep up with that great diabetes control. By this I mean that those patients had less problems with diabetes complications. This was great information for all of us health professionals because it was encouragement to push hard at the beginning and get things controlled QUICKLY instead of languishing until the situation became worse. Years ago, that is what many health professionals did-they waited until blood sugars were TERRIBLE before becoming aggressive and trying to get things under control. We were concerned about starting too much medicine too soon, and overwhelming patients who did not want to be on medicine in the first place. Now we know that was not a good idea at all, and what really needs to be done is to reign in that train NOW.

At the diabetes conference this year, they spoke of this “glycemic memory” , but from the other end of the argument: that BAD control up front will lead to difficulties preventing complications later, EVEN IF you become better controlled then. This may explain some of the recent research where tight diabetes control did not help as much as thought it would, because those folks had already had diabetes for years and bad control for some time. Perhaps their glycemic memory was of all bad control, so poor that the good control later on just was not enough to overcome those years of bad glucose control. It’s like the foundation of a house: if you have a good foundation, an okay-material house will likely still do better than if you have a poor foundation and then try to put a strong house on top of it.

So think about those first years of having diabetes as the foundation for the rest of your health life. If that foundation is bad, you have set up poor glycemic memory for the rest of your life. Trying to reign yourself in later is still better than not, but the benefits may not be as great as you hope since the damage was already done and there is no strong foundation to stand on.

Until next week, stay safe and healthy Vincies!

Anita Ramsetty, MD endodocs@endocrinehelp.com

Medical Director Endocrine Care Group

www.endocrinehelp.com

Tel: 843-798-4227