The Border

Wednesday, May 22, 2013

I didn't like getting a fasting result over 95, so I made sure I did a challenging, hilly run at lunchtime, and had a low-carb lunch afterward. The outcome was a post-prandial test result of only 104.

It isn't about steering the ship in a straight line, it's about making the right course-corrections.

 

What Is Borderline Diabetes?

I see a lot of Google search strings in my site statistics which suggest people are very curious about that mysterious twilight zone, that no-man's-land, between normal glycemia and diabetes, known as "borderline diabetes" (or sometimes "prediabetes"). What goes on in that forbidden territory -- and if you stumble into it, can you hope to stumble back out?

Some of this anxiety arises from "reification" -- the tendency to treat a purely abstract, statistically-defined concept as if it were an actual object existing in the world.

The most famous, and probably most successful, example of reification to date is "IQ". This rough assessment of a child's rate of learning compared to peers (invented for use as a screening tool to identify children with dyslexia) has become transformed, as if by magic, into a permanent biological limitation on adults. It is assumed to determine which individuals (or, to be more candid about it than is customary, which ethnic groups) are worthy. IQ has figured significantly, but largely behind the scenes, in the current political battles over immigration reform (the idea is that we mustn't let in the sort of people who tend to have low IQs). So successful has the reification of IQ become that most educated people, even if they think IQ scores shouldn't determine who has human rights, nevertheless take it for granted that IQ is an actual, existing thing, and that everybody's got one, and that their children will inherit it. Seldom has a concept so questionable triumphed so completely.

Other things which seem to be examples of reification are the inflation rate and unemployment rate -- both of which are related to actual phenomena, but both of which are defined and redefined constantly, through processes which are more or less political in nature. (How many of the people who aren't working count as "unemployed"? Somebody other than you gets to decide that.) Most of us are aware of these limitations, yet we talk about these numbers as if they were concrete objects whose existence could not be doubted.

"Borderline diabetes" and "prediabetes" (and, in a way, Type 2 diabetes in general) are reifications: mathematical abstractions which, by convention, we talk about as if they were actual objects.

The concept of "borderline" diabetes seems to me an especially unhelpful example of reification. The idea is that, if you're going to define diabetes as abnormally elevated blood sugar, then you have to decide how much abnormally elevated blood sugar it takes to qualify for a diabetes diagnosis. That magic number is chosen arbitrarily, and has changed before, and may change again. But until you hit that magic number, you remain (supposedly) on the borderline, not quite normal and not quite diabetic. This implies that the difference between borderline diabetes and honest-to-goodness diabetes is a difference in kind, not a difference in degree. And that isn't remotely possible.

It would be a miraculous coincidence if borderline diabetes and diabetes were separate diseases with separate causes, yet everyone who had the former disease eventually got cured of it, on the same day that he developed the latter disease. Who could possibly buy this story? It is perfectly obvious that borderline diabetes is simply the name that has been given to an early stage of Type 2 diabetes.

By the time your endocrine system is having any kind of detectable difficulty in keeping your blood glucose levels within normal bounds, it is clear that something is going wrong with glycemic regulation in your body, and diabetes is the catch-all term we apply to such a problem. The potential causes of this problem haven't been thoroughly explored, but once the problem has developed to the point that evidence of it is detectable, it tends to be pretty well established as a persistent personal characteristic. One can manage it -- but one cannot stop managing it. You will not necessarily remain "diabetic" forever; you certainly might be able to regain a normal or nearly-normal range of glycemia. But maintaining that happy state of affairs is going to demand care and effort for the rest of your life. You now know that your body, left to its own devices, has a tendency to become diabetic -- and you must constantly steer it away from that default destination.

The conventional diagnosis points for a diabetes diagnosis are a hemoglobin A1c result of 6.5 or a fasting glucose test of 126 mg/dl, but that doesn't mean elevated results which haven't quite reached those diagnosis points should be regarded as anything other than diabetes -- diabetes identified at an early stage, and therefore diabetes unusually susceptible to being brought under control -- but diabetes all the same.

 

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