Thursday, December 06, 2007

Diabetes Prevention: The Sad/Happy Tale of a Dropout from a Diabetes Research Study

After lab blood tests, my VA primary care provider always notes that my glucose levels are slightly elevated. She says the number is not high enough for immediate concern but that it "bears watching."

Although my mother had diabetes before she died at 84, I didn't see myself getting diabetes because I am physically active and not overweight (as my mother was). Though the elevated glucose is there, I have opted for watchful waiting.

Then a letter from the VA Healthcare System arrived. It said that I might be eligible to take part in a voluntary VA research study "to test whether an aspirin-like medication (Salsalate) helps prevent diabetes and reduce risk factors for heart disease."

A brochure described the 15-week study which would require me to make several trips to the VA center in Jamaica Plain near Boston for extensive testing. During the study, I and the other participants, 40 in all between the ages of 21 and 70, would be given either Salsalate or a placebo to see if Salsalate is helpful in lowering blood sugar (glucose) in people with impaired glucose tolerance (IGT).

IGT is also known as pre-diabetes. If initial testing showed me to be pre-diabetic, I would be eligible to continue with the study. Pre-diabetic? Is that what my slightly elevated glucose numbers made me? Having succeeding in getting my cholesterol down to 143 from 220 (see previous post), now I have to fight off diabetes?

What's this? Is maintaining good health some kind of full-time job? The answer, of course, is yes and joining the VA Salsalate Study struck me as a good way to get to the bottom of my so-called "pre-diabetes." In addition, the study is about something that I think should be the first principle of health care, for individuals and for society: prevention.
Diabetes is an epidemic in this country, now affecting 21 million Americans. Another 54 million are heading for a diagnosis of diabetes. I don't want to be one of them. And now the VA was giving me a chance confront diabetes while I still have the upper hand.

I wish that our health-care system was geared to prevention rather than scrambling after disease has done its worst. The system does little to prevent diabetes but when a victim of the disease must have a leg amputated, it springs into action.

The VA health-care system is different. It is very much about prevention. For many years, more than I care to remember, I have received superb preventive care from the VA. I see the Salsalate Study as an opportunity for me to give back. Also, this is an important study and I feel privileged to have a chance to be part of it.

Finally, this is a chance to learn something. When you have an old (69) brain like mine, new and complex information is fodder for keeping it healthy and humming along. There would be plenty of opportunity here for the mind-stretching that we now know actually generates new brain neurons.

Even finding my way to Jamaica Plain on the first day was a helpful little exercise for my brain, forcing it to navigate unknown, traffic-clogged streets. I didn't get lost, though I was glad to turn onto South Huntington Ave and see in the distance the huge VA center rising massively into the sky like an emerald city.

In the vast lobby, the Salsalate Study Coordinator, George Alexis, met me and ushered me into his office. He patiently explained what the study was all about, my rights, my option to withdraw from the study at any time for any reason, and had me sign a ream of papers.

I met his colleague in the study, Nancy Fraser, who went out of her way to escort me to the lab where blood where I had blood drawn. As George was, Nancy was friendly and conversational. As George did, she treated me as if I were a Very Important Person. And you know what? With both of them repeatedly thanking me for my participation, I felt like a VIP.

This was going to be fun. Besides doing some good and giving my brain a nice workout, I was going to make new friends. George and Nancy both talked about people in the study being like family. Hey, a chance to be family! I couldn't wait for the next visit, one of 3 or 4 hours, when we would get down to the first order of business -- testing me for pre-diabetes.

Diabetes is a disease that attacks us at the core of our existence: the way we turn food into the fuel that powers our every move. Normally, the body takes the food we eat and turns it into a sugar called glucose. The blood carries this glucose to cells throughout the body. A hormone called insulin (made by beta cells in the pancreas) changes the glucose into quick energy.

Glucose is the fuel we use to pump blood, breathe, think, walk, talk, jump, dance, and run. It's what I use to chase a tennis ball like some kind of maniac or to sit quietly reading The New York Times. Others use the fuel in a million other ways, or save it for future use. Glucose fuels every human activity.

When this system of energy conversion and use works as the manufacturer intended, it is a wonder of both complexity and efficiency. In diabetes, the system stops working the way it is supposed to, gradually, almost without notice. In one type of diabetes, the pancreas does not make insulin. In another type, the pancreas makes some insulin, but either makes too little or the body has trouble using the insulin or both.

When insulin is absent or ineffective, the glucose in the bloodstream can't be used by cells to make energy. Unused glucose collects in the blood, leading to the high glucose levels marked by untreated diabetes. Excess sugar in the bloodstream does all kinds of harm, such as damaging nerves and blood vessels. No one knows the root cause of diabetes.

Two weeks after my first appointment at the VA in Jamaica Plain, I returned relaxed and eager, along with my wife Barbara who came along for the ride. Again George met us and and we chatted easily as if we were old friends. Nancy met us with smiles. Both greeted Barbara with genuine warmth and went out of their way to make her feel welcome. They invited her to accompany me to the testing room, where they sat her about 10 feet away where she could hear and see everything.

George departed and Nancy was joined by a young woman physician from Brigham and Women's and Helen, a nurse. They sat me in a big adjustable hospital chair in the middle of the room and went to work. With some difficulty (trying both arms and returning to the first) Helen affixed a small intravenous catheter to my left arm.
"You okay?" Helen kept asking.

"No problem," I said, smiling.

"Are you cold?" the doctor asked.

"Perfectly comfortable," I said. And I was and not just physically. I was among friends. When the doctor referred to me as "a young man," I said to my wife Barbara sitting a few feet away, "Did you hear that, dear? She called me a young man."

"Oh, he's in his glory, " Barbara said so all could hear, "surrounded by three women giving him non-stop attention."

She was right. I WAS enjoying the attention. But did she have to announce it to everybody? Couldn't she have let it be my dirty little secret?

With all the attention, I was feeling pretty expansive. I told my captive female audience that I had mentioned to George that as the oldest in the program, I ought to have to special perks. "I suggested a car and driver."

My audience smiled politely, but it was clear that they were all intent on doing what we were all there for. For the next 3 hours, the team -- and the three were very much a team -- would be conducting a series of blood tests to determine how my body processes sugar. It's called an oral glucose tolerance test.

If I am found to have impaired glucose tolerance (IGT), I will be certifiably pre-diabetic and will be eligible to continue in the study. If my body reacts normally to a sugar jolt after taking 8 ounces of sugary liquid, I will not be pre-diabetic and will be ineligible for the study.

"In other words," I said, "good for me, bad for the study."

"No," said the doctor, "we see both outcomes as win-win, good for you and good for us."

For the test to be accurate, complicated procedures have to be followed exactly. Consulting a sheaf of papers, the doctor gave quiet directions and pitched in as needed.

The day before, the doctor herself had sat in this same chair and had all the same procedures, including the blood drawing, done to her. It so happened that I was the very first participant in the study. "So that makes me extra special,"I said.

"Yes," the doctor said. "You are the very first one and we wanted to make sure we get it right. So we did a run-through with me as the patient."

"I'm impressed," I said.

Then we had some fun joking about how as the first patient, I was also the best study participant in every important category, from best looking to best personality to most cooperative.

I was given the sugary drink which tasted like the sweetest Coke you ever had. I managed to get it down. "My God," I said. "How many calories in this?"

"Well," said the doctor, "You didn't have breakfast." I had to be fasting for 8 hours before the tests.

We went through three rounds of tests, with small amounts of blood drawn every 15-30 minutes and introduced into a little instant lab machine called a glucose analyzer. The nifty machine printed out results. It was brand new, having been puchased especially for this study.

Nancy manned the glucose analyzer, shown here ( the machine in the middle). Helen drew the blood each time by turning little knobs attached to the catheter, thus avoiding having to stick me anew each time. Since needles make me queasy, I was thankful for those little knobs.

The doctor watched closely, making sure that procedures were followed and occasionally making quiet suggestions and helping.

Finally, it was time for the fourth blood test -- the one that would determine whether I can stay in the study or get my walking papers. Anything below 140, I'm out. Between 140 and 199, I'm pre-diabetic and eligible for the study. Above 199, I'm diabetic.

"I have to say," I said, " that I definitely have mixed feelings about this. I want a clean bill of health but I also would like to be in the study."

"Well, we're going to find out right now," Nancy said.

Helen drew the blood. Nancy inserted it in the glucose analyzer and punched in commands. The machine printed out it's verdict. Nancy tore the printout off the machine and read, "111."

"Reaction normal," Helen pronounced."You are not pre-diabetic."

I felt elated and let down at the same time. I had slipped out from under the shadow of diabetes, but I now had to leave a group of welcoming and dedicated professionals that I did not want to leave. A big part of me still wanted to be a member of their family.

A few days later, I received a note from George and Nancy thanking me for taking part in the Salsalate Study. It ended with, "We wish you good health!"

To George and Nancy and the entire Salsalate Study team, I say, "Thank you for your rare blend of caring and professionalism. I wish you breakthrough success with the study and I look forward to reading about your life-saving findings in The New England Journal of Medicine."

So long and keep moving.

P.S. Of course, when results of the study come out and help millions avoid diabetes, I will be talking up my role in the study. I will try to remember to say that I was disinvited from the study, but we all know how unreliable the human memory is.

NOTE: My novel, State Kid: Hero of Literacy is now available on Amazon and for the Nook.

Billy Stone was a foster child.

He ran away from abuse.

He went to juvenile prison.

He went up from there.

And he did it his way.

With the power of the written word. 

Amazon E-Books by George Pollock

 "State Kid: Hero of Literacy" is fiction based on his  real-life experiences  growing up in foster homes; "Last Laughs," is the true story of how five foster kids (he and four younger siblings) found their way in life and each other. "Killers: Surprises in a Maximum Security Prison," is the story of his being locked up for 23 hours with killers in a maximum security prison;  "I, Cadaver" is about his postmortem adventures and mischief in the anatomy lab at UMass Medical School. “A Beautiful Story” demonstrates the art and process of creative writing as a 16-year-old boy goes all out to write a story that literally saves his life;  "A Long, Happy, Healthy Life,"  is about how to live the title every day; and "Unlove Story," Writing anonymously as "Elvis," a husband, dumped after 38 years of marriage, lets it all out on love, marriage, life, everything. A guy doing this? It's unheard of.
   For the Nook:

A Beautiful Story
A Long, Happy, Healthy Life
I, Cadaver
State Kid
Unlove Story



At June 11, 2008 1:02 AM, Blogger C said...

Did the intravenous catheter hurt?

At June 11, 2008 10:39 AM, Blogger georgepollock said...

Not at all. gp


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