EXPRESS_34379 Andrew-slides

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1 EXPRESS_34379 Andrew-slides Type 1 diabetes doesn't just mean one devastating diagnosis. It means four to eight times the risk for cardiovascular disease, four times the risk for cancer, 3.5 times the risk for kidney disease, 80% chance of vision impairment, increased risk for cognitive decline, and a life cut short by over a decade. Type 1 diabetes is an autoimmune disorder where the pancreatic beta cells are killed by our own immune system. Without these cells, the body can no longer produce insulin or regulate blood glucose levels, forcing us to have to medicate to replace this missing piece. What was once an autonomous body. My journey really begins at 16 years old on a family trip to Washington DC. I was pretty excited to see this historic city for the first time. The Washington Monument, Lincoln Memorial, the White House. But instead, I was struck by extreme nausea, thirst, urination, fatigue. I tried various remedies like soda, Gatorade, bread, amongst other foods to ease these symptoms, which had worked in the past. But ironically, I was only making things worse. See, after 14 hours of throwing up straight, I ended up in the emergency room at Reston Hospital Center, where I found out my blood sugar was not a normal 80 to 120 milligrams per deciliter. But instead, 596 milligrams per deciliter, six times higher than normal. I spent the next three days in the intensive care unit, where they monitored my blood glucose, but also my hydration level acutely to make sure there wasn't rapid fluctuations in either, as this could result in brain damage or other serious long term complications. Once I became a little more stabilized, they then transferred me to the general hospital, where they continued to monitor my health. But now I was taking what I would describe as a crash course on what it would now take to manage my new diagnosis. See, without my pancreatic beta cells, I was now going to be responsible for implementing a library of knowledge on how to manage my new diagnosis. The first, always going to need to be an expert on my nutrition. What was in each meal of each day. How many carbohydrates were in these foods, what type of carbohydrates, how much protein. How was the composition of this meal going to affect my blood sugar level? Next, I was then going to need to prick my finger, draw blood, and analyze how much sugar was already residing within my circulation. Maybe there was too much sugar or too little sugar. Then I would need to take the information from both my meal and my blood glucose, and make a mathematical guess as to the amount of insulin I would need for both. See, unfortunately, errors are inevitable at times, as rapid fluctuations in blood glucose can result from changes in insulin sensitivity, which can happen due to a countless number of factors, such as, how much sleep did you get? Did you take any medications that day? Were you fatigued? Did you exercise? Did you have caffeine? And the list goes on and on and on. As I mentioned, errors are inevitable, and can lead to rapid fluctuations in blood glucose, which can result in

2 symptoms such as blurred vision, irritability, fatigue, or lack of concentration. You can become sweaty, shaky. But if severe enough, you can lose consciousness, have a seizure, or go into a coma. See, at 16 years old, I realized there was a lot on the line with getting this right. And as type 1 diabetes disproportionately strikes those under the age of 18 years old, it's not just the patient, but it's also the parents, the caregivers in the family who are also in this whirlwind of a dynamic guessing game. As you imagine, I was pretty relieved to finally leave that hospital a week and a half after entering. I was finally discharged, and my family took me to do what I enjoyed doing more than almost anything, and probably still enjoy doing more than anything today, which is eat food. So they took me to a local restaurant at the bottom of the hotel where they were staying while I was in the hospital. And I remember this very clearly, because I got there and I was sitting down, and I was so excited to eat some food that was not hospital food. And I'm looking through the menu at each of the items and just thinking, what do I want to eat? And I froze. See, I had no idea how many carbohydrate were in those foods. How much insulin was I going to need to take? What do I do if I take too much insulin and my blood glucose comes crashing down? Or I take too little, and so my blood glucose goes skyrocketing? See, errors are inevitable, and a lot is on the line when getting this right. And, unfortunately, when sitting there, I realized I was no longer going to be normal again. That my life had changed forever, and I was going to be in a dynamic mathematical guessing game with each meal of each day. Since leaving that restaurant, I've tested and analyzed my blood over 50,000 times, injected myself with over 60,000 syringes, and administered over 300,000 IUs of insulin, and experienced countless symptoms of damagingly high blood sugar, but also dangerously low blood sugar level. Some of which has been life threatening. But luckily for me, I'm standing here today to tell you about my journey. But not everyone is as lucky. See, every year I hear of a type I diabetic who wasn't able to make it through one of these events. In fact, just this last week I heard of a girl who wasn't able to make it. But that's just the day-to-day burdens. See, chronically, type 1 diabetics are set up for increased risk for all 10 of the leading causes of death. But why? Why are type 1 diabetics up for these acute, stressful events, but also devastating chronic diagnoses? That's actually why I'm standing here today. See, for the past 12 years, I've been on a personal journey to try and better understand and manage my disease, which now impassions me as a scientist here at USF Morsani College of Medicine, where we study health and disease and try and find meaningful interventions for those who suffer from a disease just like mine. Now, when exploring the scientific literature on type 1 diabetes, interestingly, but albeit not at all surprising, chronically elevated blood sugar level but also blood sugar variability is often a normal, accepted part of a type 1

3 diabetics' life, is to blame for most of the risks and complications associated with this disease. But do we have to accept that? If we know the origins of the risk and the complications associated with this disease, can we find a solution? Well, for the past 10 years, I've been on a personal journey experimenting on myself. Trying various medication protocols, nutritional strategies, exercise interventions, to try and better manage my disease. Often, admittedly, at the cringing faces of almost all my doctors. But luckily for me, one particular intervention was incredibly effective. See, within the first week, my blood sugar would often not test out of the normal healthy range of 80 to 120. But see, this is just a snapshot, that really doesn't tell you what's happening to your blood sugar over a chronic period of time, which is critically important to know for a type 1 diabetic. Well, doctors often use a test called hemoglobin H1C, which is a two to three month average of your blood sugar level. Now, normal healthy range sits between 4.4 and 5.6%. But type 1 diabetics, they sit between 7% and 9% on average, meaning that a type 1 diabetic correlates to about twice the normal healthy blood sugar than a healthy non-diabetic person. Now, while doing this intervention for myself, I was able to achieve-- and this measurement was taken two weeks ago --a 4.9% A1C, which puts me in the normal, healthy, non-diabetic range. But what about blood glucose stability? See, for over 10 years I'd come on and off this intervention trying to find an intervention as effective as this one, and I've yet to find one. But while coming off this intervention, I would often fluctuate well above 120, and come crashing down well below 70. Not just daily, but often meal by meal. But while on this intervention, very rarely would I go way above 120 or well below 70. But what does that really feel like? It feels like I'm on a roller coaster ride, fluctuating up and down rapidly, accumulating symptoms of hyperglycemia, or high blood sugar, and hypoglycemia, low blood sugar, often at each meal. But while on this intervention, I felt like I was getting off this roller coaster, going into the kiddie park, and going over little, bumpy, very manageable ride. Now, what about insulin requirements? Standing here today, I'm actually taking 70% less insulin than when I first started this intervention, dramatically reducing the input that causes the biggest fluctuation in blood glucose, which is insulin, but also dramatically reducing the cost of this disease. So you might ask, what intervention gave me this improved glycemic control, dramatically reduced my blood glucose variability, and dramatically reduced my insulin requirements? The grocery store. See I simply changed my nutrition. If we look at a mixed meal, we see that it is typically composed of fat, protein, and carbohydrates. Fat. Fat has essentially no effect on blood glucose levels. Protein. Protein causes moderate elevation in blood glucose, but this can be easily managed with a regular insulin bolus. Carbohydrates. Carbohydrates minus fiber, when ingested, are broken down into individual molecules of glucose, where they are transported in the bloodstream and directly raise blood sugar levels. So for a type 1 diabetic, the higher the carbohydrate, the higher

4 the blood sugar. The higher the blood sugar, the higher the insulin. The higher the insulin, the bigger the chance for a big blood glucose mistake. See, what I did is I simply took the foods in my diet that had the greatest elevation in my blood glucose, which is starchy, sugary carbohydrates, and replaced them for nutrient-dense fat sources. This is often called a low carbohydrate diet. Oftentimes I get to enjoy foods like steak, eggs, chicken, with some type of green leafy vegetable. Now, I'm not a professional photographer, but I often find this to be a very satisfying food strategy. But one thing that's often mentioned about this diet is it's very restrictive. People feel like they're giving up their favorite foods. And no doubt about it, when you walk into the grocery store, you're giving up 60% of the foods there. Typically in the center of the grocery store. But you do get the 40%, typically on the outer rim of the grocery store, that prevent rapid fluctuations in elevations in blood sugar levels. Now, people also feel like they're giving up their favorite foods. But now with the emergence of interest in this diet, additives or ingredients for some of these favorite foods, like pizza and cinnamon buns, are now being replaced for low glycemic ingredients, so you can still enjoy these foods without the same blood glucose elevation. Now, for over 10 years I've only known of one other person to do this intervention that helped me manage my disease. But a year ago, I was introduced to an extremely motivated online community of type 1 diabetics who also happened to be doing a low carbohydrate approach. Called Typeonegrit. I was blown away. Kids as young as five and six were achieving blood glucose levels and blood glucose stability as good or better than mine. But it wasn't just one individual. It was one after another achieving these results. And not only was I blown away, but so was a Harvard and Duke research group who studied the glycemic control, but also quality of life in these patients. Their results illustrated that these type 1 diabetics, before doing this low carbohydrate intervention, had the typical double the normal blood sugar level. Meaning these patients, before using this diet, had twice the amount of glucose circulating on average in their blood. But after doing this low carbohydrate intervention, they were able to reduce their blood sugar to within the normal, healthy, non-diabetic range. But not only that, when looking at quality of life, these two studies illustrated these patients didn't feel victimized by the disease, but instead felt empowered over their diagnosis. See, I argue that my results, but also this community, illustrates that type 1 diabetics can achieve normal blood glucose numbers. And that if you understand the disease and complement it with the right nutritional strategy, you can manage this disease. See, nutrition is medicine, and evidence is emerging that nutrition plays a pivotal role in the prevention and management of numerous diseases, not just the management of type 1 diabetes. Here, at USF, metabolic medicine [INAUDIBLE], we study nutrition and metabolic therapies for cancer, Alzheimer's, neurodegenerative disorders, obesity, as we use these interventions to try and find meaningful interventions for those who suffer from

5 the diseases, and try and guide them on their path to health and disease management. Now, I was lucky enough. I was able to find an intervention that helped me manage my disease. But not everyone is as lucky. And we as a research community must work hard to try and find meaningful interventions for those who suffer from these diseases. Now, while you may not be struck by a disease, we can all be struck by burden and feel cemented into the ground when a challenge is presented. We often use the knowledge and information we are given, but it may not be good enough. And we must continue to explore to truly overcome. I argue that knowledge and personal exploration will only help illuminate the path in front of you, even if it appears to be dark. But you never know, you may have to illuminate the path behind you, so others don't have to travel in the dark. Thank you.