Diabetes

[Alan McDonald]

I am home a few days after 28 in hospitals. Short story - blackouts, new heart valve and triple bypass. Op successful and I feel great.

A few days after admission and numerous tests I was a bit of a query because I have never smoked, do not have hypertension, diabetes, a cholesterol problem and am not obese, so should not have had so much damage. Plenty of thinking time since then and I suspect I have had a problem with the valve for a very long time. I can recall odd occasions when young and extremely fit that I found I could not carry on a game or a race in the normal way because my legs would not go. Seems restricted blood flow means cutting short the supply to either the muscles or the brain and for most of the time my muscles were deprived, but the brain 3 times so blackout. The partial blockage of arteries was calcium which I was told is part of the ageing process and nothing to do with lifestyle or diet.

Pre op the diabetes status came into question and they treated me as if I was diabetic with 3xdaily blood sugar test and hospitals' diabetic diets. The test readings were very variable but showing I could be. I ensured I could test myself after discharge and have been recording levels below any shown in the hospitals. Apparently the surgery could cause levels to be high for a while too.

The reason for posting is that I wondered whether any membes are confirmed diabetic and how the discovery affected your Port intake. As a precaution I am restricting mine until after a couple of post discharge follow up checks. No reason to give them any excuses - most doctors are anti alcohol.

[Eric Ifune]

Glad to hear you got through all that.

[Moses Botbol]

Wow, that is some story. I hoping best for you and thanks for sharing.

[David Spriggs]

Wow! I'm glad that you made it through and feel better. My best wine buddy has AFIB and it really took a toll on his health.
I am not a diabetic, so can't help you with that, but hopefully someone will chime in.

[Andy Velebil]

Glad you're doing better!

[Roy Hersh]

We just had a Type 1 diabetic on our Port Harvest Tour. I was shocked he'd actually join us, but promised me he could handle it and would be spitting all the young ones. Well we had plenty of oldies and I did not see him spitting much. I did talk to him twice during the tour to see how he was doing and he wound up taking a morning off to deal with his being tired and also to get his blood sugars back in line. He injects himself with insulin every day and I can't imagine that can be any fun.

Testing your glucose level (fasting) is the best way to ensure consistency as obviously after a glass or three of Port, your sugar level will be extremely elevated. Drinking lots of water, avoiding salt, losing weight and getting in daily exercise can all be very beneficial to ward off the evils of diabetes. Most people who show early signs can do the above preventive steps or even take some meds and can reverse from pre-diabetes to non-diabetic under the guidance of a doctor.

Good luck!

[Julian D. A. Wiseman]

I’ve been a type-I diabetic for 2¾ decades, and I drink Vintage Port. Indeed, I wrote the book on it. If you want somebody with whom to speak about it, contact me.

Some guidance.

• Much of metabolism is improved by the addition of water. Before a Port tasting I drink a pint (Imperial pint, not a light short-changed swindle American pint) of water, each hour, from lunchtime until 6pm. I try to maintain that pace during the tasting, but probably fall short.

• Take the night-time insulin early in the tasting. It’s meant to be slow acting, but isn’t that slow. It helps process meals and VP. 6pm rather than midnight really helps.

• Measurement also helps. Always before bed and on waking.

• Diabetes is not a secret. Tell people. At work, those nearby; friends with whom one drinks; family; others. I have a one-page essay for such folks. Ask and I’ll share.

[Derek T.]

• Diabetes is not a secret. Tell people. At work, those nearby; friends with whom one drinks; family; others.

I have had the pleasure of sharing many Porty evenings with Julian over the past decade or more and the advice I have quoted from his post is what I believe to be the most important bit.

I have witnessed a few of occasions where action needed to be taken, not all of which Julian was aware of at the time. If you want to have Port safely with friends, make sure at least some of them know what warning signs to look out for and what to do if they spot a potential problem.

[Julian D. A. Wiseman]

most doctors are anti alcohol.

My father has a PhD in tropical medicine, has been a General Practitioner, a surgeon, and an epidemiologist.

He also had 30-year period of his life without a dry day (about which his eldest son is still impressed). Recently he’s had some dry days, but still very many very moist days.

You seem to be suffering from Poor Choice of Doctor Syndrome, which is notoriously miserable, but curable.

losing weight and getting in daily exercise can all be very beneficial to ward off the evils of diabetes. Most people who show early signs can do the above preventive steps or even take some meds and can reverse from pre-diabetes to non-diabetic under the guidance of a doctor.

This might be aimed more at type-II diabetes than type-I. The non-identicallity of the conditions isn’t always obvious to non-diabetics.

[Roy Hersh]

Yes, I should have stated Type 2, thanks Julian!

[Alan McDonald]

I thought it was time to update this with my one person clinical trial.

First, more personal information. My opening post describes the problems I do not have. I do not drink socially because my wife and I never go out socialising. When we were young we did do so, but not for about 30 years now. We have lived fairly remotely from other people all our married life and a 20 mile drive seemed OK when young, but not now. We have had the occasional friend/family visitors in that time and of course we do meet people through normal day to day life, but generally we are just the two of us working the farm (plus she has the housework) and we eat together. I drink only with meals, every night with a proper dinner and sometimes a part or full small glass at lunch. I work full time on the farm so get plenty of exercise - usually 5 or 6 hours fairly steady each day, and the usual paperwork/fiddling about between jobs, although naturally the steady work was on hold to begin with and I am only gradually coming back to it. I am not taking any chances with the various joins of my sternum, valves, arteries and veins.

I had not consulted a doctor for a few decades before the problem relating to my heart and obviously had no choice with whom I dealt whilst in the hospitals. Neither do I have a choice in the GP I see, but on the two occasions I have seen him, he seems reasonable, although following the usual lose weight, get more exercise without knowing anything about me. I have a 50" chest and 38" waist, the same waist measurement as 50 years ago and am 5'10" with short legs. I have been 198 to 202 pounds for that time too, but now about 190lbs because I have lost a lot of muscle on my legs and arms - triceps have totally disappeared. I have not seen him since the operation but will do so soon - 6months post op checkup. I am not on any medication.

I had a break from alcohol for a few weeks post op and then a small glass of wine with dinner for a while. I had a kidney stone nearly 4 years ago and the urologist said I should continue my normal habit of drinking lots of water through the day........ and some red wine. He always ended with "(pause) and some red wine".

Eventually I returned to drinking Port, slowly to begin with, but my wife and I are now back to a more respectable 3 bottles a week between us. She drinks very little table wine, but usually more Port than me, so I am probably having between one and one and half bottles a week - normally on 5 or 6 nights rather than 7 - in additon to my (mainly) red wine, say half a bottle a night.

It should be noted that my Port consumption is almost entirely Ruby, with some LBV or Colheita, and very rarely a Tawny. Please sit down if you are not already doing so. I do not own any VP. I shipped all of it to my son in October. My wife and I always obtained a lot more enjoyment from VP when younger and eventually reached the stage where the cost did not justify any extra pleasure that drinking VP might give compared to other decent Ports, which obviously are relatively cheap here.

Twice a day testing always resulted in blood sugar levels below those whilst I was in hospital. I reduced testing to once a day on 1 January and results are in the 180/190s on most occasions, with some readings over 200. In hospital I was frequently in the 230/260 range and a top of 274. I do not know how this relates to UK measurements but my GP daughter-in-law tells me anything below the equivalent of 230 and she would not be concerned.

I keep a spreadsheet record of measurements, twice a day blood pressure and temperature as requested by the heart people, as well as blood sugar. I also record the main dish of lunch and dinner so I have a good record. Blood pressure is good particularly given my age of 75 - averaging around 110 to 125 over 75 to 85. The top measure can be in the 130s if I am rushing in the mornings to go out and get some work done or go into town.

The conclusion I have reached is that a blood sugar test the following morning has no correlation to whether I drank Port the night before, or how much. There does apear to be some connection, but not absolute, to how much carbohydrate I had with dinner, a large helping of pasta or rice generally gives a higher reading, but not always, and potatoes do not appear to affect the next reading. I am not prepared to switch to a high fat no or restricted carbs diet in case it jeopardises my blood pressure and/or cholesterol/triglycerides. These will be tested again next week.

This time last year I would not have known what any of the medical words in this post meant. I do not really want to know now, but I do want to live a long time yet.

[Peter W. Meek]

Type-2 diabetic here.

I haven't monitored my blood glucose regularly for several years. I do get regular Hemoglobin A1c tests which measure an average blood glucose for the previous six months or so. I'm typically around 6.3% having crept up from my best (during an exercise program) of 5.9%. My doctor is pleased as long as I keep it below 7% (Ideal for a non-diabetic is 5.6% or less.)

I haven't been getting the regular exercise I should get for several years which is probably why my A1c has crept up. I hope to get back to regular exercise once we get settled into our new house this summer. (Alan, your history of plenty of exercise while working is probably why you are either not diabetic or have your diabetes under good control.)

I do take medication to control my blood glucose - Metformin (glucophage) 1000 mg, twice a day. It "eats up" excess glucose. Like many medications, it should not be taken with alcohol. My doctor is well aware of my drinking (5-6 drinks per day, with an occasional dry day or three, mostly red wine with occasional tawny port), but says that the risks involved with metformin/alcohol interaction are much lower than the risks of me not taking metformin.

[Roy Hersh]

Hi Alan and Peter,

What are the risks of Metforman at that level (2x 1000 mgs.) with alcohol? Drowsy, don't drive?

Thx!

Roy

[Julian D. A. Wiseman]

Sorry about my slow reply — post just seen.

You seem not to have eared your diabetes. Exercise; moderate drink; lots water; not overweight — we still don’t know the cause of type-I diabetes.

Twice a day testing always resulted in blood sugar levels below those whilst I was in hospital. I reduced testing to once a day on 1 January and results are in the 180/190s on most occasions, with some readings over 200. In hospital I was frequently in the 230/260 range and a top of 274. I do not know how this relates to UK measurements but my GP daughter-in-law tells me anything below the equivalent of 230 and she would not be concerned.

US/UK = 18. UK doctors say to target 5.0, which is 90 in US units; US doctors say to target 100, which ≈5.6 in UK units.

I keep a spreadsheet record of measurements, twice a day blood pressure and temperature as requested by the heart people, as well as blood sugar. I also record the main dish of lunch and dinner so I have a good record. Blood pressure is good particularly given my age of 75 - averaging around 110 to 125 over 75 to 85. The top measure can be in the 130s if I am rushing in the mornings to go out and get some work done or go into town.

That’s an excellently narrow range.

The conclusion I have reached is that a blood sugar test the following morning has no correlation to whether I drank Port the night before, or how much.

Also true for me, but because if having Port then I have more insulin.

but I do want to live a long time yet.

Good luck. Reading this says optimism wouldn’t be wrong.

[Alan McDonald]

Roy, sorry I missed your post in March. Please note also Julian sent me a PM to say he had posted yesterday’s response, and as on a previous occasion the notification via email had a blank space instead of the link. Both messages appeared OK in my box on the site so they are not missed.

Apologies about not responding earlier. I have no idea what effect it might have on driving. On leaving hospital last year I was taking a cocktail of drugs in the morning, and more throughout the day. I was definitely unfit to drive before lunchtime, and probably all day. When I began driving again I did not take any medication that day if I intended to drive.

I had very bad side effects - dizzy, lethargy, excessive urination, weakness, loss of appetite, digestive problems, even panic attacks. I gradually weaned myself off them because of the adverse effects. I made experiments of missing each drug separately and monitoring changes in the effects. I kept notes. I had not had any alcohol for a month when I left hospital, nor for some time afterwards, so these effects were totally in the absence of alcohol. I felt immensely better when I ceased taking everything.

I have a lot of knowledge of animal nutrition and (a long time ago) my wife studied human nutrition as part of her training to be a Home Economist. We have several decades of experience of formulating rations for different types of farm livestock and kept up to date until a few years ago when we no longer needed the information. Vitamin/mineral ratios and antagonism amongst some of them are very important. For one simple example, I am sure everybody except a committed city dweller will be aware that egg shells contain a lot of calcium. Some people provide extra calcium to laying hens in addition to what is in the formulated ration. Wrong. Excess calcium is a big problem that affects shell quality and can lead to morbidity and death of hens. I think the one item that most people are likely to be short of is Magnesium. Soil levels have been falling around the world for a few decades, so food items contain less than formerly. Might be worth having a look at your daily intake.

So I was taking nothing for a while until I saw the doc in late Feb. He was not impressed that I was not taking multiple drugs every day and sent me for an enormous range of tests, particularly blood, and re-instated the meds I had been on. I saw him again the next week with the blood test results. Everything absolutely fine (liver, kidneys, breathing, blood cells etc) apart from something I did not understand, but it was in connection with my immune system which was “not quite back to normal”. He upped the dosage to 3x1000mg Metformin because my blood sugar was permanently in the 190s. I accept this is not good.

The village is only about 3 miles away; I picked up my prescription, drove home and my wife and I decided to go into quarantine. We have not broken it, so I have not been off the quinta since then – 17 weeks isolation coming up. We have grocery deliveries into a vehicle in the yard and collect them later with protection. I have done tractor work without difficulty.

I had a repeat of all the problems as before so again, after experimentation to ensure what was causing which problem, I ceased taking everything except the Metformin, which I had to cut back. I can tolerate one per day, and that is it. If my blood sugar tops 160 I take a second one. The problem of an excess is severe digestive problems accompanied by diarrhoea for several hours. Not pleasant. I chose the 160 level without reference to anybody and it is well below the 210 the hospital used to determine whether or not I needed medication.

I recently did an analysis of my alcohol consumption, and I have no intentions of adjusting it whatever happens. It is reducing over time and definitely less than even earlier this year. Doing less work means I am eating less, so naturally drink less with the food. I would prefer a shorter pleasant life than a longer miserable one. I did the analysis because I became somewhat fed up of people on a farming forum who make remarks such as “been at the port again?” (they always use a lower case p) when they disagree with my opinion on something. After a lead in explaining that I enjoy table wines, especially pairing wine with specific foods, usually have more than one bottle open at any time, and I drink only with meals plus quite often a nightcap, I then set out my drinking habits as follows:

"Before giving quantities I want to draw attention to the fact that different alcoholic drinks contain widely different amounts of alcohol. I suppose the standard for most farmers would be a pint of beer in the local pub – say 5%. Table wines average around 12-13% so 2.5 times that of beer. In other words a pint of wine is only the same alcohol as two and a half pints of beer. Port is 19% so close to 4 times that of beer. Note this well – a pint of Port contains the same alcohol as 4 pints of beer. The Moscatel de Setúbal I drink is 17% so say 3.5 times beer. Whisky at 40% is 8 times beer.

Most lunchtimes for the past few years I have one or one and a half glasses of wine. None today as it happens – bacon and eggs. A “glass” given the size I use and the amount I put in it is about 125ml. With the main course at dinner, and sampling whatever is on the table I will almost always have two glasses. With fillet steak (about once a week) this is invariably less and usually only one glass, often less. I do not know why I have less with fillet steak. I then have Port followed by Moscatel. A bottle of Moscatel lasts me between 2 and 3 weeks. My wife very rarely tastes it so I have less than 50ml a night. I drink less Port than Moscatel so say 40ml. My nightcap of whisky (not every night) is about the same amount as the Port.

So, adding all this up, and erring on the high side, my daily consumption of table wine is up to 4 glasses; Port 40ml; Moscatel 50ml; whisky 40ml. In beer comparison this works out at 1250ml; 160ml; 175ml and 320ml. A total maximum equivalent of 1905ml. Or just about exactly 4 pints of beer equivalent a day. So, if I post after about 11pm you can assume I have had 4 pints of beer. If I post earlier than that I have had less. At time of posting I have not had any today. Anyone who is a regular drinker can decide for themselves what effect this might have on what I post. Teetotallers probably think I am a habitual drunkard. So be it. At 76 I could not care less what opinion anyone has of me. Many will not live that long."
.......................................................................................

The thing that surprised me most (I kept a tally over a few days beforehand) was how little Port I now drink. I only have it with cheese and tend to eat less cheese in warmer weather, but even so was surprised. A couple of years ago I knew from what we bought that we were drinking 4 bottles a week between us. Even earlier this year it was close to half a bottle a day. My wife still drinks more Port than me, but very little else, at most a glass of wine with the main course. In over 50 years I have never seen her even very slightly tipsy.

I hope I did not bore anyone too much, but good food and drink are extremely important to me, and dinner is the highlight of my day most of the time.