A mechanism for heart damage in Diabetes!
Frank Russo, January 04 2007.
Great lateral thinking is a real blessing, and if it sometimes fails you by making you jump to conclusions, it's usually because the information is suspect. It is generally thought that heart attacks hit you out of the blue like a thunderbolt! This however is often not the case in diabetes.
The heart of a diabetic will tend to deteriorate with time, especially if the insulin production is cranked-up all the time. Most diabetics are constantly told to keep the sugar low. However it is wrong to be told to only test the glucose after at least two hours... you must make sure that the sugar does result in a post-meal peak. This is important because one could be having low sugar salads constantly, with resultantly very low blood sugars. However your muscles need stored glycogen. In my big muscular frame I probably need about 1 kilogram of glycogen and at least 2 kilos of water dedicated to this glycogen usage. This tends to explain why people on salads loose weight quickly: they are losing their water and their glycogen with resulting muscle weakness.
This should not be very significant for cardiac muscle, for the latter is not a great user of glycogen directly. However, if one has a very strong heart, with its cells full of mitochondria - mitochondrial respiration of glucose being the process by which the heart gets a lot of its energy - then the glucose should definitely not be constantly at 4 or 5 millimoles/litre. If this becomes the case, you will find that you will have a nagging tired and sometimes painful heart, as its full range of energy may not be instantly available! On such a dietary regime, the heart may become progressively weaker with an eventual infarct as a real possibility!
Even a very high transient peak would be okay, because its brevity would tend not to glycosilate the proteins, so that bodily functions are not really impaired. This is analogous to how the 440 watts transient peaks of my MO5, (which I used to have before I sold my hifi), did not cause much damage, rather it was the Telarc's artificial loading of the tweeters in "Star Tracks" that may have been a problem!
So in conclusion, the important thing is that - like a stereo - one should have some dynamic range in his glucoses. Metformin is good because it does not appear to impair this. So do test your peak glucoses as well as your plateaus sometimes, just to make sure there's plenty of glucose available for your heart instantly!