The Inner Workings of a Challenging Puzzle
For the past 18 months my focus has been on stress hormones to get the best possible glucose control i can achieve. To me it is the most challenging aspect of optimizing my blood sugar control and consistency. At least in my experience, carbs, insulin, and exercise are like clock work and have been second nature for years. The second phase of minimizing hypoglycemic unawareness episodes took longer but has become stable. The third phase of hormone control is an Olympic event and requires the tenacity and drive of a Gold medalist in gymnastics. When i can control my stress hormones then its like a cruise ship on settled and gentle waters and its a feeling of almost being a non diabetic again. When stormy conditions form over the pacific waters with nature's bouncing swells, choppy waves, and cross wind, it closely resembles the gyration and surging of hormones in my body. The result are blood sugars that are out of step and the perfect balance of choreography between the network of specialized hormones and their loss of synchronization. It then becomes the behavior of my glucose excursions that are usually inside the lanes but becomes like a driver who has had no sleep navigating behind a wheel in the fog of a black sky with no moon.
When i have my Endo appt in a month, I'm sure the Dr will find the conversation unlike she has had with a diabetic before, type 1 (as i have been for 42 yrs) or type 2. She will see that my A1c goals, results and expectations are no less than what a non diabetic obtains meaning its between 5.0 and 5.5. When she wants to know how she can help, my agenda will be on the intricate signaling, responses and pathways of my Los Angeles metro like freeways and interchanges of hormones. For me its the last frontier of mastering diabetes.
One of the primary points i want to explore with Dr is why the behavior of my counter-regulatory hormones changes when my blood sugar is elevated, in normal range, in mild hypoglycemic ranges, and in very low hypoglycemic ranges. I know the sequence of the hormones and when each one starts to respond based on my blood sugar levels and why there is a lack of hypoglycemic (unawareness) symptoms. What i want to know is when my glucose levels have dropped into the thirties (as an example), why i have required intervention by someone else instead of my counter regulatory hormones acting to raise my levels. I notice when my glucose levels are normal or elevated there is no shortage of hormones like cortisol raising my glucose levels but they work differently when their low.
I understand i do not have the awareness or symptoms of lows but my belief is i have extensive hypoglycemia-associated autonomic failure (HAAF) and because of this, no matter how low i go, i can expect no help from cortisol, Adrenalin, glucagon, or "My Lady of Mercy". I know about the affects of various autonomic nephropathies such as:
Coronary Autonomic Neuropathy (CAN), Diabetic Autonomic Neuropathy (DAN), Peripheral neuropathy, Focal and Proximal
Below is a 3 pronged axis blueprint that i know I want to discuss that i find intriguing and by gaining a better understanding, i will know what is occurring and i gain strive to tame the hormones like a tiger trainer
Adrenocorticotropic (ATCH) hormone is made in the corticotroph cells of the anterior pituitary gland. It is secreted in several intermittent pulses during the day into the bloodstream and transported around the body. Like cortisol, levels of adrenocorticotropic hormone are generally high in the morning when we wake up and fall throughout the day. This is called a diurnal rhythm. Once adrenocorticotropic hormone reaches the adrenal glands, it binds on to receptors causing the adrenal glands to secrete more cortisol, resulting in higher levels of cortisol in the blood. It also increases production of the chemical compounds that trigger an increase in other hormones such as adrenaline and noradrenaline.
How is adrenocorticotropic hormone controlled?
Secretion of adrenocorticotropic hormone is controlled by three inter-communicating regions of the body, the hypothalamus, the pituitary gland and the adrenal glands. This is called the hypothalamic–pituitary–adrenal axis.
When adrenocorticotropic hormone levels in the blood are low, a group of cells in the hypothalamus release a hormone called corticotrophin-releasing hormone which stimulates the pituitary gland to secrete adrenocorticotropic hormone into the bloodstream. High levels of adrenocorticotropic hormone are detected by the adrenal glands which stimulate the secretion of cortisol, causing blood levels of cortisol to rise. As the cortisol levels rise, they start to slow down the release of corticotrophin-releasing hormone from the hypothalamus and adrenocorticotropic hormone from the pituitary gland. As a result, the adrenocorticotropic hormone levels start to fall. This is called a negative feedback loop.
Stress, both physical and psychological, also stimulates adrenocorticotropic hormone production and hence increases cortisol levels.
Very interesting information.
I have a thyroid and pituitary gland that seem to do what they want to do when they want to do it and rarely does it make much sense. It was only recently that I understood they are part of the puzzle.
You are a good writer.
As far as all this being a puzzle, I'm finding out it gets more and more complex as I learn more.
If i play the role of Spencer Reed from Criminal Minds, I will assume the FBI title of Profiler to solve the bodies hormones when they become 'unsubs' or commit unhealthy acts. There are 50 hormones and they travel throughout our blood stream as they act on a target cell – a cell with receptors that correspond to it.
If i bring up the inner workings of glands, hormones and signaling to a mere PCP, they will ask if I am in the wrong office. If i speak to one of my transplant surgeons about endocrinology, they will ask their nurse to sedate me as I begin to slip into dreamland until the DR is out of the building. When i brought up endo's to my oncologist a few years ago, he muttered those guys are a little strangle as a group. Whenever I want to get peace and privacy and have the room to myself, i just start talking about negative loop feedback and Adrenocorticotropics and I can hear a yawn in the parking lot. What is a diabetic to do?
For those of you who want to know what hormones can turn into, think of the holiday shoppers on the dawn of Black Friday in long lines just waiting to barrel like a crazed flock of dogs into the Apple Stores, Walmart discount centers, and Trader Joe markets. Or the challenge of supervising a playground of kids ages 6 to 13 after being locked up all day classrooms. If i were God and had to create the human body I would have simplified the blueprint and designed beta cells in the pancreas with an encapsulated force field oblivious to our body's immune system of T cell soldiers and for type 2 diabetes, there would be no genetic insulin resistance.
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