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Malcolm Graham
March 30, 2008
Gender: Male Ethnicity: Caucasion Height: 5ft 10in to 6ft 0in Weight: above 170 lbs Onset Age: 41-50 Age Now: 41-50 Family Diabetes: Mother Treatment: Diet&Oral Medication: Metformin,Glucophage Meter: LifeScan Tests: 5-6 times/day Exercise: None Diet: Zone (30/30/40) Supplements: see details

Who am I? What do I believe? These are questions I've been asking myself for years!

I was born in Carlisle, Cumbria, UK and moved to Canada in March 1982; I currently live in Carp, Ontario. I studied electronic, control, and computer engineering and am a British chartered engineer (CEng). For the past 22 years I've been earning my living as a technical writer/manager. For the last five years I've been working for Nortel and currently label myself an Information Engineer.

For years I was not a happy person! I didn't seem to have energy or enthusiasm for anything. I was very irritable and easily annoyed at both home and work. I attended an anger-management course in 1998 and attended a number of counselling sessions during 1999-2000. In June 2000 my Medical Doctor (MD) prescribed 20mg/day Paxil to put me on a more even keel. It worked, but there were a number of side effects: I felt kinda numb (no, I don't mean dumb) and I lost interest in sex! In addition, I was plagued with an almost constant yeast infection.

Diagnosis and initial treatment

In November 2000, my eyesight changed dramatically over a one-week period , my long-distance vision became very blurred and I found it difficult to read anything with my glasses. I was also very thirsty and drinking a lot of water. It was about time for my annual check up anyway. All the usual blood and urine tests were initiated. My MD made a diagnoses of Type 2 Diabetes (see Canadian Diabetes Association and American Diabetes Association) because I had a fasting blood glucose level of 16.7mmol/L (multiply by 18.02 to convert to 301mg/dl) and my glycosylated hemoglobin (HbA1c) level (11.2%) indicated that my blood glucose levels had been high for at least 2-3 months. My cholesterol level (5.98) was also higher than normal but my MD decided to ignore it until my next checkup in March 2001. She immediately started me on 500mg/day Metformin (Glucophage). After two weeks the dose was increased to 500mg twice/day. I experienced diarrhea for a few days. Protein was found in my urine and my MD prescribed 2.5mg/day Inhibace (Cilazapril); which was increased to 5mg/day on January 25, 2001; and 10mg/day on March 15 2001. Inhibace is usually prescribed for high blood pressure, but in my case it is being prescribed to act as an ACE inhibitor to help my kidneys. My initial reaction to my Diabetes diagnosis was disbelief followed by annoyance with myself for neglecting my health and allowing Diabetes to blossom.

My MD referred me to the Ottawa Hospital for a Diabetes information and training session in December; however, I couldn't attend because my father died in late November 2000, and I attended his funeral in the UK. My blood glucose control during this time was less than stellar! I attended the Diabetes information and training session on January 4, 2001. The session was useful but the diet advocated seemed weighted towards high carbohydrates and the doctor seemed less than enthusiastic when I mentioned I was taking a Green Barley supplement; the expectation seemed to be that I was there to be told what to do and not to question the advice of Diabetic Clinic staff! That's when I decided I needed to consult with a Naturopathic Doctor (ND) for supplementation guidance. I attended a more extensive two-day diabetes training course on March 6-7, 2001 at the Ottawa Hospital; again I found the training useful but noted the strong resistance to taking supplements (I was told you can get all your nutrients from a well-balanced diet) and told not to trust information I read on the Web. Again I received the impression that the Diabetes Clinic staff consider themselves the experts and that I should only trust the information they give me.

Within two weeks of being diagnosed, I had purchased a Roche AccuSoft/AccuChek Advantage Blood Glucose meter and starting monitoring my blood about 2 to 4 times per day during November and December 2000. I subsequently changed to a LifeScan FastTake meter because it needs a smaller blood sample, is faster, and has the ability to upload data to my PC. I would have preferred the TheraSense Freestyle meter, but I couldn't find a local supplier. On March 9, 2001, I exchanged my Roche Advantage meter for a new LifeScan Ultra meter and started using it on March 26. See meters for my evaluations and how to use a meter to determine what to eat and when.

My average fasting blood glucose level was 12.8 mmol/L during November and December 2000. Although improved, I obviously needed to do something! Especially when I learned that my prospects using traditional treatment methods didn't look too promising (after 7-10 years many Type 2 Diabetics end up on Insulin as well as increased oral medications).

Selecting a diet and supplements

Over Christmas 2000, I started looking for the best possible treatment methods to ensure I live to a ripe old age without loosing any of my major parts! I discovered that a healthy diet and regular exercise are very important to controlling Type 2 Diabetes. In January 2001, I started myself on a diet based loosely on the The Age-Free Zone by Barry Sears and the Fresh Start Metabolism Program by Cathi Graham (not a relative). My main meal targets are 15g fat/ 30g protein/ 45g carbohydrates (note the 1/2/3 ratio and that this equates to 30/30/40% calorie contribution ratios; using 1g fat=9 calories and 1g protein/carbohydrate=4 calories). Most of the time, I try to eat carbohydrates with a low glycemic index. I also started myself on a vitamin/herb supplement regime based largely on the recommendations made by Kathi Mead, ND, in Natural Treatments for Diabetes. My next step is to get started with a regular exercise program; I've been saying this for the past 5 years, I guess I'll get started in 2006! For the past 2 years I have done some exercise, but not on a regular basis; during the summer of 2004-2005 I did swim every day and in 2004 I played soccer once a week but I didn't play at all in 2005 because of sore knees.

I started logging what I eat at each meal and recording my blood glucose levels immediately before and two hours after each meal (see a sample from my Food Diary). By the end of January 2001 my average blood glucose level was down to 8.2 mmol/L (147.8mg/dL) and I'd reduced by Metformin to 500mg/day by January 5, 2001. My eyesight is better than it has been for years and my yeast infection cleared up. My long-distance vision returned to normal and occassionally I was able to read without my glasses (this lasted for about a month, I now have to wear reading glasses again). As of April 1 2001, I'd only lost about 6 lbs (from 208 to 202 lbs), I guess while I'm eating better, I still need to reduce the amount I eat! Overall, I have more energy and I'm enjoying simple things again (like a leisurely drive in the countryside). Something is working. Paradoxically, my Diabetes diagnosis has also made me more aware of how valuable life is and focusing on dealing with the disease is enabling me to enjoy life more.

I'm noticing that my blood glucose level is still high first thing in the morning (8 mmol/L and above) and I'm investigating why and trying different things to get it down. I learned that this effect is known as the "dawn phenomena" and is due to the pancreas releasing glucagon that causes the liver to release glycogen in response to a low blood glucose level and in anticipation of a higher level of activity. On January 30, 2001, due to Metformin's effect of limiting the release of glycogen by the liver, I decided to start taking my 500mg Metformin and 5mg Inhibace in the evening, instead of in the morning. I'm also being more careful what I eat in the evenings. As of July 11, 2001, this change hadn't affected my morning readings. I started taking an additional scoop of Whey protein around 10:00pm in October 2001 to minimize the withrawal symptoms while weaning myself off Paxil; a side benefit was that on most mornings my blood glucose level was under 7 mmol/L (126.1 mg/dL).

I've been taking a number of supplements since January 2001 and reviewing and recording any changes on a monthly basis.

Digression...a medical emergency

I had a blood sample taken on Tuesday January 23, 2001 to check the impact of Inhibace. On Wednesday, January 24, around 6:00pm I received a phone call from my MD's nurse asking me to go to the hospital immediately! I asked why? "The level of potassium in your blood is high, please go to the hospital immediately!" I felt fine, better than I had felt for years. However, I happened to be browsing at the time, so I searched for "high potassium". At the top of the search results list was a link to Dialysis Report Card. It states that "Elevated potassium levels lead to ventricular fibrillation with cardiac arrest. This is a medical emergency." I reached a quick understanding why the nurse wanted me to go to the hospital immediately! I went! I went immediately! I was there for over 3 hours and eventually told that my serum potassium (K+) level was 4.2 (the normal range is 3.5 to 5.8) and that bad results were not uncommon. I was relieved! Lesson learned? Diabetes is a serious condition and we should pay close attention to how we feel and react to anything newly introduced into our bodies and take immediate action to anything unusual.

Aches, pains, concerns, and progress

For the past few weeks I've noticed a weakness and aching in my right elbow. I analyzed what supplements I was taking to see what could be causing this. I concluded that it was probably my MSM supplement, so I reduced it from 2000mg/day to 1000mg/day on February 6, 2001. By February 9, the weakness and aching was a lot less; on February 12, I stopped taking MSM and started the Natural Factors GlucoBalance supplement. Although my blood glucose control is much better, I suspect it is mainly due to my diet (I would attribute 80% of successful blood glucose control to diet). Started Glucosol supplement on March 3, 2001, and adjusted existing supplement dosages; within a week my blood glucose levels were reduced by 20%!

Since I now believe that Paxil is dealing mainly with symptoms induced by the onset of Type 2 Diabetes, I started weaning myself off it; I'm down to 10mg/day and should be off Paxil completely before the end of February. I stopped taking Paxil on February 12 2001. During the week I become more irascible and, at the insistent promptings of my wife, I started the Paxil again at 20mg/day. I seemed to have picked a bad time to stop! The stress level at work had increased significantly (I work for Nortel, who at the time were laying off 20,000 employees; and, from day-to-day, I was wondering about job security and how to feed and house my family if I lost my job). In addition, I think my body had enough to deal with with my change in diet and supplement regime. I planned to wean myself off Paxil later in the year. It also occured to me that how I deal with stress was probably a factor that contibuted to my Diabetes, and that I needed change how I reacted to stress. After reading, in September 2001, that Paxil causes a depletion of glutathione in body cells which in turn causes glucose metabolism problems, I decided to try again and wean myself off Paxil. See my Paxil withdrawal experiences. I stopped taking Paxil completely by November 5 2001. To compensate for some of problems dealt with by Paxil, I started taking St Johns Wort and Kava but stopped because they didn't work for me. After a severe depression resulting in two months off work, I started taking Manerix in May 2002. Based on my personal experience and research, I believe that most diabetics should not be using any type of SSRI drug. I also think that all diabetics could improve their overall condition by adding a Whey protein supplement to their diet.

On February 12 2001, I awoke with a mild rash on the back of both hands. Cause? My initial reaction was to suspect an allergic reaction to one of my supplements. However, I hadn't changed anything. Cause? I remembered that I hadn't worn gloves the previous day and that it was very cold that day; I concluded I had a mild case of frost bite and suspect that my current supplements are making my skin more sensitive. On February 14, I felt lightheaded, very tired, had been experiencing diarrhea in the mornings for a few days, and my elbow and muscles were still aching. Need to check with MD/ND about possible causes. On the positive side, also on February 14, my fasting blood glucose level was 6.4 mmol/L; this is the lowest its been since I started monitoring my blood glucose levels last year.

During the week, March 5-11 2001, I had 4 days when my fasting blood glucose level was below 7 mmol/L, the main contributing factor appears to be Glucosol, which I started taking on March 3, 2001. On March 9, 2001, had blood taken for a number of tests. Saw my MD on March 15, 2001; my blood test results show marked improvements from November 2000. My fasting blood glucose level has dropped from 16.7mmol/L to 7.0mmol/L (58% improvement). My HbA1c test showed a similar improvement, from 11.2% to 6.6% (41% improvement). I plan to continue with my diet and supplements and get started on an exercise program. In May 2001, my HbA1c was 6.5%, a slight improvement (-1.5%) from March; in August 2001, my HbA1c was 6.7% a slight worsening (+3%) from May; in November 2001 my HbA1c had improved to 6.4% (-4.5%). While my blood glucose levels are under control, but with room for improvement, my cholesterol and triglycerides levels are still too high. I'm particularly confused by, and concerned about, the significant increase of my triglycerides from 1.04 in March 2001 to 2.44 in November 2001, a +135% increase! For the next six months I will be focusing on reducing my triglycerides. What was I doing between November 2000 and March 2001 to reduce my triglycerides from 2.25 to 1.04 (54% improvement )? At present, I've only been able to identify two items: I was eating a lot more eggs then (about 12 to 2 eggs/week now) and I changed the amount of B3 from 90mg/day to 450mg/day in February 2001.

I thought I could get better guidance on controlling my diabetes from an endocrinologist than I was getting from my family doctor Dr Mundi. I was wrong! I went to see a Dr Lochnan at the Ottawa Civic hospital on December 3, 2001. What a waste of time! I was seen by a medical student who took a precursary medical history and performed a superficial physical examination; I was then allowed to talk to Dr Lochnan for about 5 minutes. Dr Lochnan's focus seems to be on getting fast results and ongoing control with the use of drugs; she even said that I should be taking more Metformin because my HbA1c level of 6.4 was too high; there was no discussion of increasing my exercise level or eating less. The only supplement that she thought was of any use was Folic Acid and said that she was unaware of any of the double-blind clinical studies on any of the other supplements I'm taking. When I mentioned I had consulted with a naturapathic doctor about my use of supplements; she obviously didn't think much about naturapathic doctors or that they could possibly contibute anything that might be helpful. I left feeling that I wasn't doing too well, that I was an idiot, feeling very stressed, and with a significantly higher blood pressure than I had before I talked to her! I will not be visiting Dr Lochnan again nor will I be recommending that anyone see her! I find myself wondering about how many of Dr Lochnan's long-term patients end up on multiple medications and insulin and suffer from diabetic complications! How accountable are doctors for the long-term treatment of patients? Who tracks and audits how well patients respond to treatment options? I talked to Dr Mundi the next day and agreed I would continue to work with her as my main point of contact to the rest of the medical profession. I did see another endocrinologist Dr Phyllis Hierlihy on April 15, 2002 and urologist Dr Sahajpal on July 18, 2002 (no problems found). Dr Hierlihy thought I was doing very well but recommended I increase my Metformin dose from 500mg once/day to 500mg twice/day and suggested I try Starlix (Nateglinide) to try and lower my post-meal blood glucose levels. I followed her advice and since then my HbA1c has been under 6%!

Throughout 2001-2003, although they didn't deteriorate, I wasn't successful in improviing my lipid levels. So for 2004-2005 I focused on improving my lipid profile: reducing my triglycerides and improving my cholesterol levels. While Dr Mundi was on materity leave another doctor recommended that I try Crestor and gave me some samples. When I got home I did a search on Crestor and very quickly discovered that the rate of kidney damage in Crestor patients is 75 times higher than in patients taking other cholesterol drugs; since I already have signs of kidney damage, I did not take Crestor! I printed out the materials and talked to the prescribing doctor who showed no interest in the materials I'd collected and stated that I couldn't trust information from the web and that she trusted her own sources! The end result was that I stopped trusting her! In March 2005, Health Canada advises patients about the risks of CRESTOR® (rosuvastatin); there are also currently a number of Crestor lawsuits in Canada.

During 2002, I was successful in getting my blood glucose under control; my HbA1c was below 6% for the last 9 months of 2002 (as of March 2004, 24 months). At times I haven't watched my diet very well or even recorded what I ate. I do remember buying a four-pack of Twix bars and eating all four within one hour! I didn't bother checking my blood glucose levels for the rest of the day! To try and gain greater control before I slide too far back into bad habits, I purchased a software product called Diabetes Diary and started using it in January 2002 but I didn't use it much throughout 2002-2006! Another area for improvement! During 2003-2006 I planned to track what I ate using RMRdiet or Diet & Exercise Assistant on my Sony Clie; I didn't! Indeed, I haven't done very well throughout 2006 and in January 2007 my HbA1c had reached 9.6! Time to get back on track!

Plans and goals

I plan to continue my involvement in Diabetes education. I will continue as a registered volunteer with the Canadian Diabetes Association and updating my web site. In early 2002, I participated in a new Health Canada diabetes awareness program in which my story, along with others, was told. In December 2002, I joined the Canadian Diabetes Association Professional Speakers Bureau to present sessions on Preventing and Controlling Type 2 Diabetes. In May 2003, I was awarded a Special Achievement Award by the Canadian Diabetes Association for my volunteer work. I plan to continue my volunteer work.

My overall goals are to continue to keep my HbA1c below 6% and my weight to 180 lbs with less than 25% body fat by December 2008. I'm searching for other things I need to do. My current goals are:

  1. Follow, for each meal, the principles of Zone Diet with 15g fat/30g protein/45g carbohydrates for each main meal and a maximum of 1800 calories per day with a focus on using carbohydrates with a low glycemic index. Also adopt more of the recommendations from the Fresh Start Metabolism Program by Cathi Graham. Eat more low glycemic index foods using my Palm-based Glycemic Lists SmartList as a guide.
  2. Record, daily, all the food I eat using the Palm-based Diet & Exercise Assistant software.
  3. Monitor and record my blood glucose 4 times/day immediately before and 2 hours after each main meal.
  4. Achieve a monthly average blood glucose level below 6.0 mmol/L (108 mg/dl).
  5. Improve my lipid profile by December 2008. Cholesterol: increase HDL and maintain above 1.2; reduce and maintain LDL below 2.5; and reduce Cholesterol/HDL ratio to below 4.0. Reduce and maintain triglycerides below 2.0.
  6. Reduce weight to 180 lbs with a body fat level of less than 25% by December 2008.
  7. Exercise 3 times/week for 30 minutes/day using HealthRider; walking; or swimming.
  8. Learn to breath better! Review and apply the ideas espoused in the Body Flex videos by Greer Childers by July 2008.
  9. Initiate a full complement of blood tests and see my doctor every 3 months.
  10. Maintain and update monthly an online diary of what I eat, my blood tests, my supplements, and my research notes.
  11. Review, adjust, reduce, or change dietary supplements and medications monthly.