Why Do We All Wait Until We Get Sick Before We Act?

How is it we all know better what health means or what taking care of ourselves means, but in reality we fail? Do you remember a few weeks ago when I started moving and exercising? Somehow under the strain of the physical effort combined with the calorie deficit, I almost ended up in the hospital. My blood sugar played a trick on me and reminded me why you have to take care of yourself. As it seems, there is nothing serious, nothing that cannot be fixed, but the idea of “I’m on a diet” has taken on a whole new meaning for me.

Last week, toward the end of my consultations at work, I started feeling dizzy. Although it initially went away, it came back later that evening at home. Apparently, a blood glucose level of 80 mg/dL is too low for me. Somehow, I have adapted to higher concentrations, even though this is not yet visible in my HbA1c. Apparently, I am completely healthy and yet I did not feel well. From the data I managed to collect quickly over the last five days, my blood sugar fluctuates a lot whenever I eat carbohydrates or drink sugary soft drinks. It rises quickly and falls just as quickly, to the point where I physically experience the drop as hypoglycemia. That means: waves of heat, dizziness, restlessness, feeling unwell, mild tachycardia, and sweating. These symptoms appear suddenly and last anywhere from a few minutes to several hours.

When I came back from my vacation in Spain, I stepped on the scale, motivated. 1 8 5! 185 kg! How the hell did I get to 185? I used to be the guy who exercised three hours a day—bodybuilding, Aikido, Karate, Kung Fu. What the hell am I doing now? Sumo? I’m not even fit enough for sumo! Not with the dizziness I’ve been having. For those of you reading from the US, I don’t even want to convert into pounds, because I have absolutely nothing to gain from that conversion, considering that numerically my weight almost doubles. Somehow, I came back from vacation too motivated and exercised too much, ate too little, and combined intermittent fasting with a calorie deficit that was simply too severe. That led to my problems. The reality is that I’m glad they happened. All they did was push me to become even more motivated to lose weight, except now we’re talking about a fight for life and death, aren’t we? Today I was sitting and thinking about how I could start my next post or what I could write to you. I don’t even know whether it’s a good idea to put such personal things online, but my wish is simple and clear: I want to help all of you who are in the same place I am. This is only possible if I am honest and transparent.

For more than a week now—about ten days today—I have lost weight down to 179.4 kg. I exercise at least three times a day. In the morning, I wake up at 6 and exercise for about 20 to 30 minutes. Most often, it is a combination of walking and strength exercises with weights. In the morning, I try to focus on weights and stimulating muscle mass. Obviously, it cannot be too much as long as the exercise itself lasts no more than 20 minutes. At lunchtime and in the evening, about 15 minutes after each meal, I go for a walk. I walk at a decent pace for at least 30 minutes. At first, I needed breaks, but after a few days of exercising three times a day, I can already see that my stamina is beginning to improve.

My blood sugar has stabilized as well. At first, physical exercise was accompanied by dizziness; somehow, my blood sugar would drop too much and it would take a very long time to rise again. In the meantime, I’ve noticed that it no longer drops as aggressively. The measurements are done using a FreeStyle Libre 2 and regular capillary blood glucose tests. I’ve noticed that the Libre’s subcutaneous sensor is not very accurate; most of the time, the blood glucose measured directly from blood is around 20 mg/dL higher than what the Libre shows. So if it shows me a blood glucose level of 90 mg/dL, most of the time I actually have a little over 110 mg/dL. I can’t say it bothers me very much that the values aren’t extremely precise. I’m happy that the difference remains relatively constant, because that means I can use the trend. You have no idea how my blood sugar explodes if I eat carbohydrates or drink a beer. It goes from 120 to 190 in about 30 minutes. It’s like a fucking space rocket.

Since I started exercising regularly, my blood sugar fluctuations have begun to settle down. The peaks are getting smaller and smaller, and the lows are becoming less and less abrupt. The problem is that the cellular receptors have become desensitized to insulin, making it harder for sugar to be transported into the cells. It therefore remains in the blood. A further increase in blood sugar causes an additional release of insulin, and it becomes a vicious cycle that ends with a sufficient amount of insulin finally pushing the sugar into the cells. If this mechanism somehow fails, blood sugar remains elevated for a longer period of time, and only then can we see it in laboratory tests as an increase in glycated hemoglobin. HbA1c (glycated hemoglobin) is measured as a percentage, namely how much of the hemoglobin shows evidence of exposure to sugar in the blood. The longer the cells spend swimming in sugar, the more this value increases. The method has one limitation: these cells survive in the blood for around 100 to 120 days. So we can effectively measure a meaningful new value roughly every three months.

In my case, right now, the pancreas eventually manages to push the sugar into the cells, and because of that my HbA1c is not elevated at all. So this test would not show anything, and in fact it didn’t show anything. I have measured it twice in the last two months. The problem appeared now because the period of intermittent fasting combined with exercise and a calorie deficit caused my insulin resistance to suddenly decrease. The cells became better at accepting sugar. As I consumed carbohydrates, my blood sugar exploded, my pancreas secreted huge amounts of insulin, and that insulin moved the sugar into the cells without much effort, since the cells had suddenly become very receptive. This rapid movement caused the sudden drop in blood sugar. And that is where the second part of the problem appeared: my blood sugar no longer rose again as quickly as it should.

Blood glucose can rise again through two main mechanisms in the liver. First, the liver can break down its stored glycogen and release glucose into the bloodstream. Second, it can produce new glucose through a process called gluconeogenesis. Both mechanisms are stimulated mainly by glucagon and other counter-regulatory hormones. However, when insulin levels remain high, the liver is strongly inhibited from releasing glucose. Therefore, blood sugar may continue to fall until insulin levels decrease enough for the liver’s corrective mechanisms to become effective.

One week and three episodes of dizziness later, I managed to understand what was happening to me. The only solution: regular exercise! Or regular movement after every meal! After doing this over the last few days, however, I noticed something else: I no longer need to urinate every two hours. The reason is that my blood sugar rarely goes above 180 mg/dL anymore, even after meals. At the same time, I sweat less, and my mind is sharper than ever. My blood pressure has dropped dramatically. Before, it was around 150/90 mmHg while taking three medications (candesartan 32 mg, indapamide retard 1.5 mg, amlodipine 10 mg). At the moment, it is 130/70 mmHg on only 32 mg of candesartan. I stopped the other two. As my blood sugar stabilized, my diastolic pressure began to fall. Initially, I was actually worried about why I was starting to have such a large difference between my systolic and diastolic pressure.

I feel like I’m 20 again. Fresh and strong. It’s strange how you have to reach 40 years old to realize that only now is it time to get your ass moving and become healthy again. I’ll continue with another post about nutrition; for now, these are the thoughts I wanted to share with you. Here, I am being as transparent as I can for one simple reason: to offer something to those who are in the same situation as I am. Think about the fact that the rest of my laboratory results are normal. If I didn’t have the luxury of being a doctor and having access to practically any laboratory investigation, I don’t know how quickly I would have reached the diagnosis. I don’t even know whether another colleague would diagnose me correctly if I showed up with dizziness but without suspicious laboratory results. I don’t even know whether I myself would be able to properly diagnose and treat a patient like this. The only reason I managed to reach a diagnosis relatively quickly was because I was experiencing all these symptoms myself, constantly reanalyzing and reinterpreting them. But if someone sitting across from me had simply described all of this, I probably wouldn’t have reached the conclusion nearly as quickly. But that remains a theory for another time. Exercise after every meal!

See you in the next post!