“The experts” say that by the time one is diagnosed with T2 diabetes, over half of one’s islet cells have been compromised. “They” also say that our diabetes can exist in a subclinical state for years before diagnosis. We’ll probably have to wait another generation or two for researchers to piece together the interactions of genes, environments, and triggers for all types of diabetes before clear paths of development emerge. Once that happens, hopefully we will be able to “catch and treat” insulin metabolism disorders before diabetes, and its associated complications, can take hold.
There’s a bit of a rub here… something that makes me think that either there is already a precursor sign or symptom. I suspect that rather than diabetes being a cause of feeling cold, or the two conditions existing alongside each other, hyperglycemia (and/or diabetes) may be a secondary effect of thermoregulation issues (i.e., body temperature consistently lower than “normal range”, and/or constantly feeling cold). If so, then I may have been nursing a predisposition, or a subclinical version, of T2 for almost 30 years before I was diagnosed. And if my hypothesis is correct, there may also be a correlation between thermoregulation and Dawn Phenomenon.
In Survival of the Sickest: The Surprising Connections Between Disease and Longevity (Harper Perennial, 2008, ISBN 978-0-06-088966-1), Dr. Sharon Moalem posits the evolution of (T1) diabetes as a survival benefit in extreme cold environments. He does this, in part, by bringing our attention to plants and animals whose cold-weather survival behavior is to eliminate excess water, raising the concentration of sugars in the living tissues, and thereby preventing ice crystals (and death).
I had another near-hypothermic episode last night, while I was (arguably) wide awake, and I also know that when I wake up shivering at night or in the early morning, my blood glucose levels will be higher than normal for me.
Based on my normal oral temperature being between 97.2F and 97.9F, and having assorted issues when that temperature drops below 97.0F (which it does frequently enough in winter), I have to presume that I have some issues with thermoregulation. My doctor has done tests to figure out the cause of blue fingers in cool environments and ruled out the obvious; we had just let it drop as “a side effect of the diabetes”. While the technicolor nails are a new development since diagnosis, feeling cold in a room that is barely below “standard” temperature is something I’ve been dealing with since seventh grade. The trigger was a bad HVAC system in the junior high school (no heat at all in one room, too much heat in the next room, seemingly random distribution). One would think that absent the stress, the response should disappear. It didn’t. (BTW, I have comparable issues with hot-and-humid environments.)
Given all the above, I’ve come up with my own (arguably crackpot) hypothesis: a primary thermoregulation issue, in which on the one hand, the body has either a lower-than-normal thermal setpoint, or a reduced ability to regulate its core temperature, resulting in low body temperature – and on the other hand, the perception that it must protect itself from freezing, resulting in a secondary rise in blood glucose level. Thereby positing a reason for persistent hyperglycemia pre-diagnosis, and explaining seasonal morning hyperglycemia in cold environments.
If this is the case, then I could conceivably have been running around with borderline secondary diabetes for close to thirty years before diagnosis. With an obvious marker sign.
It’s a bit off-the-wall, I know, but somebody has to ask the weird questions. And to remember to check my body temperature the next time I wake up in the middle of the night, shivering uncontrollably. And to see if anyone else is crazy enough to try doing the same thing alongside a 2AM blood glucose check.
BTW, I’m not excluding T1 from this hypothesis – though in T1, I would be more prone to see thermoregulatory stresses as triggers rather than as a primary cause. (Interestingly, this whole thought experiment brought to mind an incident from back in grade school that has a roundabout odd connection to Dr. Faustmann’s research. But I’ll put that in the next entry.)