So, you miraculously reached type 2 diabetes remission in just 100 days! Yay! Let’s celebrate! But isn’t that it now? You’re done, right?
No, of course not! Firstly, true diabetic remission is measured by getting your HbA1c result to 48mmol/mol and keeping it at or under that level for 6 months. So even if there was nothing else to do but maintain, I’d still be here talking about it.
But as you’ll know if you’re a long time follower, or just happened to read yesterday’s recap post where I asked the somewhat tongue-in-cheek question “why did it take me so long?”, you will know that one of the reasons I didn’t address my diabetes sooner was that I got hit with the common double-whammy comorbidity – diabetes is often joined by hypertension. And my blood pressure skyrocketed to as high as 206/112 – which is classed as “hypertensive crisis!”
It’s at this point that you are at severe risk of either a stroke or a cardiac incident.
While diabetes is a slow, insidious disease, where high glucose levels in your blood gradually damage and ultimately kill off your nerves, starting with your extremities (feet, then hands) as well as your retinal nerves, leading to blindness, loss of feeling and related complications, hypertension is called “the silent killer”. Often presenting no symptoms at all (as in my case) until it’s too late and you have a stroke or heart attack, which of course can be fatal.
I had to stop exercising and fasting because both can increase blood pressure, something I simply couldn’t afford to risk.
You may also have seen me talk about how I was able to halve my blood pressure medication as a result of losing so much weight – I reached a point where I was over-medicated and experiencing low blood pressure and even fainting episodes.
But since halving my meds, my blood pressure has still been somewhat erratic. While nowhere near as bad as it was at the outset, I’ve still had days like this last Tuesday where my first reading was 160/102! I always take three readings in a row as often the first one is high – it takes a while to just relax into it. But my second and third readings on Tuesday were 150/96 and 155/93 which puts all of the readings in the “stage 2 hypertension” category – one step down from “hypertensive crisis”.
Shouldn’t I go to the doctor with such high readings? Not necessarily. My previousl readings a couple of days before were 140/90, 136/89, and 136/88 which is “stage 1 hypertension”. It’s not unusual for people adjusting their medication to see such big changes as your body has to adapt to less support from medication.
This week I’ve been fighting off a really bad cold / flu virus, and today I’m feeling much better – so this morning’s readings of 144/93, 140/89, and 139/87 weren’t actually that bad. Many illnesses can result in spiked blood pressure, since they provoke a ‘stress response’ in the body, releasing adrenaline and cortisol, which naturally constrict blood vessels and raise heart rate. My elevated seated readings today are likely my body still being in ‘defense mode’ from the virus.
I do watch these changes closely, especially if I’m stressed or ill. If I had a few days in a row of stage 2 hypertension I would definitely talk to my doctor – it’s feasible that even though I’ve made an incredible transformation, losing 30lbs (14kg), and achieving type 2 diabetes remission, the cuts we made to my medication might have been a step too far. I might still need to adjust my medication again.
The biggest reason that I am reluctant to increase my dosage again is that there is a flip side to the coin of BP medication. These medications reduce your blood pressure, and I’ve now had two separate instances where low blood pressure has resulted in my fainting – both times linked to what is called “cough syncope” when I’ve had a cold/flu and coughed so hard I literally passed out.
As well as taking my seated blood pressure, I am also in the habit of taking my standing blood pressure – so after my three seated readings, I then stand up and almost immediately take my BP again. At this point, we are watching for the “standing drop”. While you are seated and relaxed, your body naturally needs to maintain less “hydraulic pressure” in the system. When you stand up, the blood vessels, especially in the lower body, tighten up to maintain a healthy level of pressure. If you’ve ever experienced mild lightheadedness when standing up, this is because your vascular system isn’t able to respond to the change in position quickly enough. This is called “orthostatic hypotension” (note – hypo not hyper!) and can be quite dangerous – if your system doesn’t respond appropriately, you can simply faint, which from a standing position can be very dangerous.
Orthostatic hypotension is classed as a drop of 20 points of systolic pressure (the first reading), or 10 points of diastolic pressure (the second reading). Today, mine dropped 52 systolic points and 17 diastolic points!
While my seated BP wasn’t too bad, my standing drop was atrocious! I went from 139/87 to 87/70! If my starting blood pressure had in fact been “healthy”, let’s say 120/80, I would almost certainly risk a fainting episode.
Being on blood pressure medication is, therefore, a bit of a double-edged sword, since part of the effect of these medications is to relax your vascular system, but a relaxed vascular system is what leads to orthostatic drops.
So as long as my BP is not dangerously high (which I class as two days of concurrent stage 2 readings), I will just let it ride and keep monitoring. Every week that goes by, as I continue to exercise, fast and eat more healthily, my need for medication to support my blood pressure should reduce.
The plumbing vs the fuel
The main thing is that by removing the diabetes from the equation I’m helping my blood pressure hugely – there are very good reasons the two conditions are often diagnosed together. But the thing to remember is that type 2 diabetes is caused by putting the wrong fuel in your engine. Too rich a fuel in terms of glucose is not good and casues harm (nerve damage) – but it’s “easily” fixed. Change the fuel, and you very quickly begin to see improvements.
Hypertension is not a fuel issue, it’s about the plumbing. High blood sugar doesn’t just sit in the blood; over years, it causes systemic inflammation and oxidative stress that physically stiffen the arterial walls (atherosclerosis). It’s this stiffening that makes the engine less responsive. At the same time, type 2 diabetes is often (although not always) associated with obesity. As you increase blood sugar, you put on weight, and this excess weight requires further adaptations from your plumbing.
Studies show that a 1kg drop in body weight can be typially equated to a 1 point drop in systolic pressure. I’ve actually seen well inexcess of a 60 point drop from my initial crisis readings. Why is this? Because I haven’t simply lost weight. And this is really important. Yes, weight loss is important because carrying excess weight makes the body work harder every minute of the day, which increases blood pressure. But you HAVE TO CHANGE THE FUEL.
You CAN lose weight just by cutting down on the amount of fuel you put in the engine, but if you’re still using the wrong fuel then you will only see minimal benefits.
Exercise is also important. By using the machine regularly and more intesively, it automatically becomes more efficient and effective. You are not only changing the fuel, and shrinking the plumbing, but you are increasing its overall efficiency. This is why I’ve seen such a huge transformation in my health.
Changing the fuel is the quickest and easiest thing you can do for yourself, but if you want to change the plumbing then it will take time.
I still have my delayed diabetic check up in a months time, on 5th May, and I’ll be very excitedly showing them my MonitorMyHealth HbA1c test results. But I also always go armed with my blood pressure spreadsheet, and this will paint a more grounded picture, showing that my health transformation isn’t over yet. I’ve come a long way, and reducing my blood pressure medication is a huge step, but there’s still work to be done.
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