T1 Improving Vagus Nerve function

I have been on the OmniPod for 8 months, and Dexcom G6 for 2 years and am seeing an improved HgA1c. I have always been under 6.2. Now I am working toward staying under 5.9. My diet is primarily vegetables, eggs, cheese and meat but I still eat some WW breads and crackers.
After 30 years as a T1, I am recognizing the beginnings of vagus nerve issues effecting my body.
I am interested in your experience with exercises, foods, mindfulness, etc. on how you work to improve your vagus nerve function in addition to lowering the HgA1c.

Back in 2012 I was diagnosed with gastroparesis, mild yet still significant. I used that diagnosis to completely overhaul my diabetes treatment regimen. That diagnosis supercharged my motivation and allowed me to make many lifestyle changes that greatly improved my health. I sense that you are in very much the same spot I was back then.

Please forgive me if I come off as the pedantic teacher who lectures endlessly about boring topics. I will answer your questions but I think a little context helps. You may already be familiar with this context but many readers are not.

It’s the vagus nerve that connects all the digestive organs to the brain. It services the autonomic nervous system, all those things that are controlled automatically without conscious thought. Things like moving food through the stomach, small intestine, then the large one. It also performs important functions like the heart pumping and body temperature. It’s the main nerve of the parasympathetic nervous system. It complements the sympathetic nervous system.

The parasympathetic system is often thought of as the rest and digest nervous system while the sympathetic nervous system is characterized as the fight or flight system. These two systems are coordinated and when one is dominant, it supresses the other. I found that I spent too much time with the sympathetic nervous system dominant and that inhibited my parasympathetic system from doing its job.

Nervous system balance is helped with good quality sleep. Getting enough sleep at the same time each day is important. Another tool that helps me balance my nervous system is meditation. I try to do this every day but my consistency is a work in progress. Breathing exercises also help.

As I’m sure you know, chronic hyperglycemia impairs nerve conduction, especially the longer nerves like the vagus nerve. I find the standards proposed by medical professionals and their associations to be unambitious and risky in the long term.

While some people with diabetes can live a healthy and long life targeting blood sugars in the 70-180 mg/dL (3.9-10.0 mmol/L) range, that glycemia is not healthy for everyone. The thinking that sets these standards is shooting for the best range for the most people and heavily weights avoiding severe hypoglycemia at the expense of chronic hyperglycemia.

You are blessed with access to a CGM and that tool, combined with drive and motivation, can yield amazing results. The two most important statistics that flow from consistent CGM use are time in range (TIR) and variability as measured by standard deviation (SD) and coefficient of variation (CV). The CGM and these two metrics are way more important than the A1c number. Forget about A1c and concentrate on TIR, SD, and CV.

I suggest considering squeezing the standard 70-180 target range to something narrower. I think 70-140 is both beneficial and doable. Hitting 80% TIR 70-140, I believe, helps stabilize and even reverse poor nerve health.

Glucose variability as measured by SD and CV are important factors, I believe, in long term health. Metabolically healthy people enjoy SD around 15 mg/dL and under 20% CV.

While those of us with diabetes can find it difficult (or impossible!) to reproduce these metrics, I think reaching for them and coming up a bit short is still a worthwhile project. I can often hit a SD of 20 mg/dL and 22% CV. Right now I’m a bit higher than that but working to bring it back to the lower numbers.

It’ll be the rare doctor who supports these goals but you are the one with skin in the game. That perspective makes all the difference.

I use a low carb way of eating to enable meeting these ambitious goals and it looks like you are already biased in that direction. It is not the only way of eating that can do this but one that works well for me. I’ve been able to sustain this eating style for over nine years now.

I do not eat any grains (whole grains or otherwise) as they make glucose management harder. I also believe that eating grains adversely affect my heart health. They are not essential for life and I think I’m much better off without them. There are work-arounds if you absolutely feel the need for them in your diet. Nut flours are utilized by many people to bake bread that they find a reasonable substitute.

The vagus nerve is thought of as the wandering nerve and my long-winded answer shares that feature. I think you could help stabilize and possibly improve your vagus nerve health by working on these issues:

  • Change your glucose target (if you haven’t already done so) to 70-140 or better and shoot for 80% in that range.

  • Follow glucose variability closely. Shoot for a SD around 20 mg/dL and a CV of around 22%.

  • Minimize or better yet, cut out, all grains and other processed carbs from your diet. If anything you eat comes packaged with a long ingredient list, avoid it. Foods known by a single name and recognizable by your grandparents are what you want to eat.

  • Don’t drink any carbs unless you are treating a hypo.

  • Adopt a daily mindfulness habit like meditation, yoga, or breathing exercises.

  • Attend to your sleep hygiene. Religiously go to bed at the same time each day and keep your sleep environment cool and dark. There are many books currently on the market that examine this issue.

  • Avoid eating within 4-5 hours of bedtime. You’ll improve your sleep quality a lot by doing this.

  • I think fasting, even just missing one meal/week, helps with glucose management and overall metabolic health.

I think you have a lot of levers you can pull that will help you. Realize that any improvements you make will take some time to make their beneficial effects felt. Adjust your expectations to months and years instead of days and weeks.

Good luck and I hope I didn’t overwhelm you with too much information! I think my health, not perfect by most measures, has fundamentally improved in the last nine years.

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All I know about the vagus nerve is that you improve health by not touching it when you intubate someone because it can stop your heart. That’s one of the dangerous things about intubation.

thank you Terry. Your experience is very meaningful to me. I have already reset my Dexcom high line down to 140 from 150. I think I really must stop eating grains and will move toward that. Keeping my SD in a closer range seems to be my main issue, especially when I do not eat the right things or eat too much at a meal. I will think this thru more and reach back out to you in coming days. We are headed to the beach tomorrow for a week. We are taking our own food…SMILE. Robert

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I have vasovagal syncope, and have since I was a tiny child. Basically, whenever my fingers/hands/elbows get injured, my blood pressure drops and I pass out like a rock… Usually waking up sometime later in an ambulance with sky high blood sugar because everyone around me thinks I’m having some kind of diabetic episode and dosed me with sugar or glucagon.

I never linked it to my diabetes, though. I’m not even sure if they are connected. I thought neuropathy tended to affect smaller/weaker nerves first. I haven’t had an occurrence that landed me in the hospital since 2005 or 06, though, so maybe taking better care of my diabetes has helped? I had just chalked it up to a change of lifestyle where I’m not anyone else’s liability anymore (nobody to freak out and call 911), and taking more care to protect my hands.

This is a new one on me, Robin. Although I am aware that there are people who faint at the sight of a needle.

That’s a credible hypothesis and nice that the incidence has gone down. Seems like it could be dangerous if it was triggered while in a precarious position. Does the low blood pressure quickly correct when this happens?

The vagus nerves control a lot of the important background functions, like heart, lungs, etc… So if you over-stress them, you can essentially stop these critical functions from working until the nerve signals get un-jumbled. In my particular case, it seems to be tied into the median nerve, which goes through the inside of the elbow and down through the thumb and nearby fingers. If I receive a lot of pain on that particular nerve, my vagus nerve can’t get the more important signals through. I have no idea WHY, it’s just always been that way.

Things that have set it off are whacking my thumb with a hammer, when my dad accidentally slammed the car trunk down on my hand, when some lady tried to force the public restroom door I was holding open for her shut on my thumb, etc…

It’s always a delayed reaction, too. Lots of crying (or cursing as I got older) and flailing the injured hand before everything blacks out and my face hits the floor.

I have no idea, being unconscious and all. I always lived very near a hospital until recent years, so I would guess I regained consciousness somewhere before 10 minutes passed. I was being facetious when I mentioned waking up in the back of an ambulance. I always came to still on the floor where I passed out, but with paramedics already on scene surrounding me. I’m not really sure how much of that time was critical, either, if any. The way the doctor explained it to me, your heart still pumps, just not as effectively as usual. The passing out is sorta like my body going into conservation mode before effective communication is restored and it can reboot.

There was only once when I think I was in any real danger, and it was because of the poor circumstances of where it happened, as you mentioned… Nothing to do with the vasovagal syncope. I was working as a microbiologist in a soap and lotion factory, my first real job after college. We had a large piece of equipment we only used rarely, and got pushed out of the lab to be stored out of the way in a halfway while not in use. As I was moving it one day, I managed to get my arm pinched between the door and equipment… And down I went. But only partially, I was kinda dangling from my stuck arm behind the door. Unfortunately, there was another set of doors positioned 90 degrees from the ones I was stuck in, the swinging kind with small windows way up higher than I was, and someone smashed my head when they threw the doors open. I had a banged up temple, too, so they think I smashed my head on the corner of the incubator when I initially passed out. That one cost me 3 days in the hospital… And ridiculously enough, my job. Apparently in all the head injury commotion, nobody did the drug test on me that OSHA/workers comp requires. I was rushed to the nearest hospital to be stabilized, even though they weren’t a workers comp facility, then transferred to a second hospital. The second hospital didn’t get the memo that I was a workplace injury until after the 24 hour drug-testing window had passed. I imagine everyone was just confused, assuming I was a diabetic emergency and not knowing how the head injury and unconsciousness played into it. My medic alert tag only said “diabetic”. Hardly enough room on them to add “vasovagal syncope”.

Thankfully, that was also my last incident! Though, it was probably a good 10 years before I really started to rein in tight control. I can’t know if they’re related or not.

@RLS1 I’m curious what you’re seeing that makes you think vagus nerve. Have you actually been told that by a medical person, as opposed to more generalized neuropathy?

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This was very beneficial Terri. I’m so glad you shared this. I’m in a desperate place and this has really helped.

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Stewey – I’m so sorry to read about your struggle with desperation. That you find my words helpful warms my heart. A brain armed with the right knowledge and an attitude of possibility are formidable forces we can use to improve our health. Not perfect but better. I wish you the best. – Terry

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Thx Terri,going to take some of what you say to heart and see what happens.
Type1 Stewey

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I don’t know if this info will help anyone but here goes. So I ended up in this totally backwards from everybody else. There is an autonomic nerve disorder Baroreflex Disorder that is caused by damage to the Vagus nerve cluster in your neck and that is the only way to get it (I had a benign tumor removed and the Dr. hit the Vagus nerves in my neck). It extremely rare as in only 2 places in the US do diagnostics so I got to go to Mayo. I am going on 11 years w/ it and it has caused all sorts of issues including Gastroparesis (new drug Motegrity is a big help). So if you are investigating what Vagus nerve issues can look like you could take a look @ Baroreflex disorder only downside is present research info does not cover all possible problems and their is no ongoing research on it. It is too rare so not good at attracting research $. The only medication that minimizes it’s impact is clonidine and in fact the final definitive on diagnosis is if clonidine helps that is what you are dealing with. Whether it would help w/ damage due to T1 I really do not know but might be worth trying. Also I am LADA which got diagnosed 2 years ago @ age 59 after years of your T2 when turns out I wasn’t. Hence my comment that I am coming at this backwards.

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Curious what gastroparesis symptoms Motegrity helps with? First I’ve heard of that being used off label.

I was diagnosed with Diabetic Autonomic Neuropathy, after almost 50 years with Type 1. My brain has been described as the gas and the heart the motor and they are not always in synch. My blood pressure yesterday was 78/45 and I ended up in bed for three hours as I could not stay awake. I take Midodrine and Fludrocortisone Acetate 0.1 MG Oral Tablet to help this. Along with electrolyte water and leg sleeves for compression. Eight out of 15 days in July, I have been down in bed sleeping because of this. Diabetes by itself is not something that bothers me, but DAN is taking away my waking hours in consistent 2.5 to 3 hour chunks!

yikes that is a scary thing. I have been dealing with low heart rate and low blood pressure, but nothing so drastic as you are dealing with.
I was told by my doctor that neuropathy is not likely, but still I dont know what the symptoms are.
My A1c is 5.5 so I cant see that tight control is the issue.

How is your control? will tightening it help with the neuropathy you are experiencing?
Can you take some drug to raise your pressure? or can you eat massive ammounts of salt?

Which ones do you do, @Terry4 ? I have been looking at some advocated by Wim Hof (on Youtube, of course!) They seem simple enough, though rather time-consuming. (Advocated by someone on the Diabetes.co.uk Forum for helping the heart.)

Good luck @Stewey. I tnink you are going in an excellent direction. I do hope you will soon feel more peaceful along the way.

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I have not been doing any breathing exercises advocated by any health gurus but I did hear someone describe breathing in a 4 second inhalation followed by an 8 second exhalation pattern. I use that regularly and I think it’s relaxing. When I inhale, I always do it through my nose.

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I do eat a lot of salt, per Dr. instructions!!! Which I love… Plus the RXs Midodrine and Fludrocortisone Acetate for low blood pressure, but do not see any results. My last A1C was 5.3, which is the lowest it has ever been.
No, tightening the control will not fix this one! The Drs go about repairing the nerve, such as the inflammation which has caused this! According to Debra Turner DNP, FNP-C. She is one of 500 Drs worldwide working on this particular item. If I remember correctly, the fluctuation of what goes on with our Vagas nerve can cause this.
There is a 'Tilt Table" designed for autonomic dysfunction testing. Which is how I was diagnosed. She is located in Memphis, TN if you are interested.
Congratulations on your A1c! Keep on going…

Thank you!

Just a note, you do not have to give up grains etc to achieve the goals of good glucose management. I am at a TIR of 90% of between 70-140, 22 SD and 20% CV. I like to aim for above 96% TIR of between 65-160 myself. I am at 98% TIR of that.

I am a vegan and I eat lots of fruits, veggies, grains, beans, I enjoy whole grain crackers, breads and pasta. I believe grains are very important for the microbiome of our gut and our general health.

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