Elevated Blood Sugar Contributes to Memory Decline

Thanks to the web site Beating Myeloma for pointing out this New York Times article about a recent study reported in the Annals of Neurology, published by the American Neurological Association. The study of 240 elderly "nondemented" subjects was done at Columbia University Medical Center.

Key findings reported in the study abstract:

• People with diabetes tended to have hippocampal dysfunction, exhibited as memory decline, and
• Elevated blood glucose (sugar) was specifically implicated as the cause of this dysfunction.

I don't have access to the full article, but the New York Times author had the article and gives quotes from one of the authors. Here are some other findings and implications reported in that New York Times article:

• Using MRI, researchers actually observed reduced blood flow in key parts of the brains of people with elevated blood glucose;
• The effect (memory loss) can be observed even when levels of blood glucose are only moderately elevated;
• Glucose regulation worsens with age; and
• Though the age-related change may be subtle, the increase in blood glucose is still a risk.

Happily, though, we can all do something about this issue:

• Physical exercise has been shown to improve glucose regulation;
• Even light physical activity can help; and
• Weight loss has also been shown to improve glucose regulation.
• It is possible that drugs which lower blood sugar may help, but those studies are not complete.

Why does this matter to people who are not diabetic?

The study had nothing specifically to do with myeloma. However, those of us who are taking dexamethasone, prednisone, or another corticosteroid may have elevated blood sugar even though we don't have diabetes. We may be diabetics on DEX day. If so, the recent study suggests that we are also at risk for memory decline. What can we do?

• Exercise intentionally and regularly, and
• Maintain an ideal weight. Personally, Weight Watchers has worked for me.
• Eat well. Enjoy a plant-based diet, with grain and meat in moderation, and little or no empty carbohydrate. Vegetables, fruit, and nuts all contribute to our health, whereas soda pop and Twinkies detract from it.

What about the corticosteroid itself?

• If you're on high-dose dexamethasone (40 mg/day four days in a row), please discuss this dosage with your doctor. A landmark study has shown that high-dose DEX results in a lower survival rate than reduced dosages;
• Get a blood glucose monitor and measure your glucose several times over one day to see how well it is regulated.
• I use the Accu-Chek Active meter, which is very inexpensive and widely available. I think I bought it in a Target store.
• My non-medical opinion: Most readings should be below 125 mg/dL, especially the first reading of the morning before eating, but readings in the hour or two after meals may go higher and readings on DEX day may be higher. Any spikes over about 180 are a matter of concern.
• Again, I'm no doctor. You should bring the results and discuss the issue of steroids and blood glucose with your prescribing oncologist. If you are not totally comfortable with the answer, discuss it also with your primary care physician, who deals with diabetics on a daily basis and may know more about blood glucose than your oncologist.

Here is a personal story: After my initial visit to Mayo Clinic I was on CC-4047 daily with 40 mg dexamethasone (DEX) once weekly. Although my oncologist, Dr L, didn't ask me to do this, a couple of months later I measured my blood glucose on "DEX day," having taken the DEX the evening before. All of the 27 readings taken that day were above 120, and one was above 190. The average was 144. When I showed this to Dr L at our next appointment, she reduced my DEX dosage from 40 mg to 20 mg once weekly.

One point of that story is that the high blood glucose may have been harming me without any warning, because I didn't "feel" anything wrong. Another point is that we need to be in charge of our own health, and watch out especially for health issues that fall outside of the normal domain of our oncologists.

Be strong, be well.



Lunch: Leftover free-range no-hormone no-antibiotic bison potroast with onions, homemade organic pumpkin with pecans (crust-free pie), organic strawberries.