Sunday, May 21, 2017

Type 2 Diabetes, a Dietary Disease #381: My Next 30-lb Challenge: 4 weeks in…

After losing 31 pounds in 10 weeks this winter, and learning how easy it is to do a full-day (300 kcal/d) “fast,” without hunger, I relaxed a bit, and I immediately regained 4 pounds in the first week. So, I decided the best way to preserve the weight loss (and A1c benefit: -0.5% from 5.8% to 5.3%), was to start a new challenge: to lose 34 pounds (30 + 4) over 16 weeks, leading up to my next doctor’s visit. For the Design Protocol, see #378.
Week 1: That “first week,” in which I regained 4 pounds after my doctor visit, I let my guard down a bit – not much really – okay, I had a milk shake after seeing the doctor. I deserved it, right? But I paid for it. Even my fasting blood sugars (FBG) were elevated (93 average) with a couple as high as 105mg/dl (5.9mmol/L). Gone were the days of the 60s and 70s. My body stubbornly refuses to take up sugar after such transgressions. I lose insulin sensitivity; my insulin resistance is elevated, at times for many days, even with Metformin. Go figure.
Week 2: I started Week 2 behind the 8-ball. Besides the 4 pound gain in Week 1, my Sunday main meal was a shrimp cocktail and a large bowl of salted peanuts, plus 2 cocktails. See, my body shouldn’t trust me. I gained another 2 pounds (from the salt). The next day I dropped the water weight but was still deep in the hole. And then on Tuesday we ate out before theatre…which didn’t go well. You don’t want to know the details; suffice to say my FBG on Wednesday was 111. So, to start both a FBG drop and weight loss, I began a 2-consecutive day fast. The result: after 1 day, while forgetting my spritzer and my pills (including Metformin and a diuretic), my FBG on Thursday was 94 and I dropped 4 pounds! By Friday, I’d lost 3 more and my FBG was 82. I ended the week with a 5 pound weight loss and a 91mg/dl FBG average. Back on track!
Week 3: Two weeks into this new 30 (34 really) pound challenge, I was down 1, leaving 33 more to lose in 14 weeks. I knew that was doable, so long as I continued with at least 2 days of fasting a week, with perhaps a boost from a 3-consecutive-day fast, or two, if required “by circumstances.” Well, “circumstances” happened. (I love the passive voice; it’s so useful at times.) Monday night we went out to dinner, and I had 3 slices of really good crusty bread, slathered in butter, while waiting for my entrée…and I paid for it. After 4 days in the low 80s, next morning my FBG jumped to 102mg/dl. So, I decided that instead of alternate day fasting this week (Tuesday and Thursday), I would do a 3-consecutive-day fast. I need to protect that new 5.3% A1c!!! Result: The 3-day fast was easy. For the week I lost 4 pounds and posted an 83mg/dl FBG average. Not bad.
Week 4: This week I’m just doing alternate day (Tuesday +Thursday) 300kcal “fasting.” I’m on track to achieve my 4-wek goal, and Wednesday is my birthday. Oops, a premature expectation. I cheated on Tuesday (some junk food in the pantry), and well, Wednesday was my birthday. Okay, so I’m human. My weekly FBG average climbed to 91mg/dl with no day over 100…but the trend line was not good. I also gained 4 pounds (largely water), putting me 6 pounds behind schedule. Clearly, I’m off-message, and I need to do another 3-day fast.
Discussion: My 4-Week goal was to get to 210 (8 weeks to 202, 16 weeks to 187), and I missed it big time. At my August doctor’s appointment, my goal is to rack up another 5.3% A1c and reach 187 lbs. So, I will soon be entering “new territory” here, and we’ll see what’s possible. I remember writing several years ago ("My Goal Weight and the BMI Table") and ("How much Protein Should I Eat?"), that “goal” or “ideal” weights were subjective and basically unattainable for people who have been eating the Standard American or Western Diet for their entire lives. “Lean Body Weight,” on the other hand, was the weight that should be used to compute the body’s protein requirement because overeating protein just puts amino acid stores in the liver which become the building blocks for glucose via gluconeogenesis. That’s a major reason we take Metformin, to suppress this gluconeogenesis. I am now trying to eat just 60 grams of protein a day, and a “lean body weight” of 187 for me, while still “overweight,” now seems achievable:  BMI of 27, vs. BMI of 54, 15 years ago.

Sunday, May 14, 2017

Type 2 Diabetes, a Dietary Disease #380: Newcastle Diet (“Counterpoint Study”)

The “Newcastle Diet,” as it seemingly is practiced today, is not the same as the original diet developed at Newcastle University for their “Counterpoint Study,” conducted in 2009 and published in 2011. I wrote about this study four years ago in "Reversal of Type 2 Diabetes" (#88) and "'Reversal of Type 2 Diabetes' Revisited"  (#89). Column #88 garnered the most page views of any column I have ever published due to the appealing but misleading title. Note: My column titles were in quotes because they are the paper’s authors,’ not mine.
The author’s use of “reversal” in the title is misleading because of their definition of “reversal”: “Reversal of diabetes” was defined by them as “achieving fasting capillary blood glucose < 6.1mmol/l [110mg/dl] and/or, if available, HbA1c less than 43 mmol/mol (6.1%) off treatment.” In my book, that is neither a “reversal” nor a “cure,” as some would claim. A FBG of 110 is smack in the middle of “pre-diabetic” (which begins at 100mg/dl (5.6mmol/L) in the U.S). By way of reference, many doctors consider an A1c of 5.7% (39 mmol/mol) – the threshold for “pre-diabetes” – to be incipient type 2 diabetes. That’s because it’s manifest evidence of Insulin Resistance (IR), the cause of type 2 diabetes. “Pre-diabetes” is simply an arbitrary point on the IR continuum.
Why is the Newcastle Diet called the “600 kcal diet”? Quoting from the Newcastle University 2011 paper, the dietary protocol of the “Counterpoint Study,” “consisted of a liquid diet formula (46.4% carbohydrate, 32.5% protein and 20.1% fat; vitamins, minerals and trace elements; 2.1 MJ/day [510 kcal/day]; Optifast; Nestlé Nutrition, Croydon, UK). This was supplemented with three portions of non-starchy vegetables such that total energy intake was about 2.5 MJ (600 kcal)/day.” That’s why the Newcastle Diet is called the “600 calorie diet.”
However, Diabetes.co.uk, which funded the study and has the only official description of it on the web, now says it is 800 kcal diet, comprised of “Optifast meal replacement sachets, which provided 75% of the calories (600 calories). The other 200 calories came from non-starchy vegetables.” Then, “Note: The diet is referred to as the 600 calorie diet (rather than 800) due to the meal replacement aspect of the diet totaling 600 calories.” Wrong! The Optifast portion is 510 kcal, but I guess NHS doesn’t want Brits trying such a “drastic” (600k cal total) diet, and certainly not “without the help and approval of a dietitian or doctor.” Good luck with that!
Note also the macronutrient composition of the Optifast part of the original Newcastle Diet: 46.4% carbs, 32.5% protein, and 20.1% fat. That’s high carb, very high protein and low fat. And that’s not counting the 3 servings of “non-starchy vegetables,” which if you ate them would boost the carb content higher, to 55% of the 600 kcal diet and 66% carbs in the 800 kcal diet. That is how you developed diabetes in the first place!
In addition, the 32.5% protein is much too high. Virtually no one recommends more than 30%, and hardly anyone eats more than 20%. Americans eat 15% on average, and the Nutrition Facts panel on packaged and processed foods is based on 10% protein. Any protein that your body does not take up in 4 or 5 hours is stored in the liver and is used to make glucose (or fat!). In T2s, suppressing this unwanted gluconeogenesis is one of the things that Metformin does. So, basically, Newcastle is a low-dietary-fat diet, but since your body has access to its own fat for fuel, if you burn a pound a week, it’s a pretty HIGH-FAT diet AT THE CELLULAR LEVEL.
Okay, so why does this diet work? The answer is that it is fundamentally a very low CALORIE diet. On this the authors agree. They conclude, “Normalization of both beta cell function and hepatic insulin sensitivity in type 2 diabetes was achieved by dietary energy restriction alone” (my emphasis). Makes sense. You eat less. You lose weight. In this respect the Newcastle diet is similar, both in mode and outcomes, to bariatric surgery…but tremendously safer. And in lieu of the 300g of carbohydrates that the typical Western 2,000 kcal diet includes, the original Counterpoint Study (600 kcal) version would have 59g of carbs from Optifast and 23.5g added for “non-starchy vegetables” = 82.5g total. So, in addition to being very low in DIETARY fat, the original Newcastle is low carb! In the higher-fiber 800 kcal version recommended by Diabetes.co.uk, the carb count climbs to 132 grams, no longer considered “low-carb,” but it’s still pretty low compared to 300 or 375! Good for the gut too.
300g of carbs is the RDA in a 2,000kcal diet; 375g in 2,500kcal (for men). Surely everyone knows, even if the NHS and the ADA and the public health establishment won’t admit it, TYPE 2 DIABETES IS A DIETARY DISEASE. As such, the best treatment for type 2 diabetes is a HIGH fat, moderate protein, LOW carbohydrate diet.

Sunday, May 7, 2017

Type 2 Diabetes, a Dietary Disease #379: “Man-up, guys!”

Okay, I have been, or should have been, saying this to myself for years, but…let’s face it: straight talk like this is too confrontational when addressed to oneself. And it’s condescending when addressed to others, so it’s usually left unsaid…but not “unthought.” It’s subtext for the way we think of ourselves and others think of us.
In this instance, the context for this exclamation is eating strictly Very Low Carb (VLC). The benefits, which I have realized for 15 years and espoused since I started writing this blog in 2010, are manifest. Besides losing weight easily (my original motivation), and doing it without hunger, I am so very much healthier by every measure my doctor uses…and I feel so much better and am totally energized.
But eating strictly Very Low Carb is difficult… because it requires change. I have for these 15 years considered it my goal, and, it must be said, have adhered to the protocol at times better than at others. As regular readers know, over a few years in the beginning, following first Atkins Induction (20g of carbs/day), then Bernstein’s 30g/day program for diabetics, I lost 170 pounds. Of course, my blood pressure and cholesterol improved dramatically. My triglycerides dropped to <50mg/dl (<2.8mmol/L), and my HDL doubled to the 80s (high 4s).
While I have kept most of the weight off, and my blood lipids continue to be stellar, my A1c has been disappointing, at least to me. In this respect I get no acknowledgment or agreement from my doctor. He is in the business of treating the sick and those whose health and diabetes are poorly managed. He dispenses pills. And most doctors (not mine) dispense bad dietary advice. I don’t blame them. They’re expected to follow the medical establishment’s Standards of Practice and the Medicare and insurance company guidelines.
My A1c has been in the high 5s/low 6s (38-48mmol/mol) for more than 8 years. Of course, from a physician or RD or CDE, this result elicits praise. The ADA considers an A1c of <7.0% “optimal.” They believe that my A1c is proof that my type 2 diabetes is “well managed,” i.e.  “I don’t yet need progressively more medications!”
The high A1c level that the medical establishment has set for the care of type 2 diabetics  -- ≤7% for the general population and ≤ 8% for persons over 75 years – is a disgrace because of the increased health risk associated with it. BUT this low bar is the result of 1) limited success in using drugs to manage the disease, 2) ignoring the fact that type 2 diabetes is a dietary disease and is thus best managed by the patient and 3) the dietary advice given by doctors to the diabetic or pre-diabetic patient is JUST PLAIN WRONG – in fact, it is the polar opposite of what “healthy eating” should be for type 2s: to wit, to restrict carbohydrates.
So, why do I now say, “Man-up, guys”? Because I finally did it! Ergo, this is as much addressed to me as to others. Please don’t view it as condescending. It is not meant to be. It is meant to be just a statement of fact. I finally did it, and two weeks ago, here in #377, I published the result: a greatly improved A1c. My previous A1c was 5.8%, eliciting nothing but satisfaction from all who heard it.  I was hoping to see an A1c ≤5.5%, with an emphasis on the “less than,” and I wasn’t disappointed. My A1c dropped 0.5% from 5.8 to 5.3 (34mmol/mol).
Comment: This result was the outcome of eating strictly Very Low Carb for 10 weeks. I also fasted on two alternate days a week, and a few times on 3 consecutive days. For most of the 10 weeks I prepared my own meals: just a 12oz coffee with 1½ oz of cream for breakfast, and on non-fasting days, usually a “light” lunch, and then supper (including about 6oz of protein: fish, veal, lamb, or offal), in a stove top preparation cooked with vegetables. Sometimes I grilled meat and had a big salad. All suppers were accompanied by 10-12 oz of red wine (in 2 spritzers); on fasting days, just one spritzer. I hardly ever ate out until the last 2 weeks, when I rejoined my wife and we were travelling, but I continued my fasting routine. Altogether, I lost 31 pounds.

Sunday, April 30, 2017

Type 2 Diabetes, a Dietary Disease #378: My Next 30-lb Challenge: Project Design

As everyone who has ever lost a lot of weight knows, the worst thing you can do is waste the effort by gaining it back. And gaining it back it so much easier than losing it. So the best defense to avoid gaining it back is a strong offense, i. e., to immediately launch another campaign to lose weight. And that’s just what I’ve done.
I made this decision exactly one week after the conclusion of my original 10-week, 30-pound challenge (originally 2-month, 20-pound challenge), in which I lost 31 pounds. During this last week, I regained 4 pounds and my FBG average climbed to 93mg/dl. Ugh! So, the new challenge is actually to lose 34 pounds. The length of the new challenge will be 16 weeks, again to coincide with my next doctor’s appointment in early August.
In this new challenge I intend only to report at 4-week intervals. At the mid-point (8-weeks or June 11th), I should have reached 202 pounds, my lowest weight since my original 170 pound weight loss. I lost 170 pounds after starting to eat Very Low Carb, first on Atkins Induction (20g/day), then later on Bernstein (30g/d). That was also my weight at the conclusion of Basic Training in the U. S. Army in 1960, 57 years ago. By the end of this Challenge, I should have reached 187 lbs, exactly half the weight I started at in 2002 (375 lbs).
For reference, 187 lbs is still smack in the middle of the “Overweight” range in the BMI chart. I am starting this new challenge at 217lbs, which is still considered “Obese.” It was also my weight during my teenage years.
CHALLENGE DESIGN: As before, on most “FEASTING DAYS” I will strive to eat about 1,200kcal: 100g of fat, 60g of protein and 15g of carbohydrate. The carbs will actually range up to 30g to accommodate my daily 1 or 2 spritzers, never more. Breakfast on these days will consist of a 12oz coffee with 1½ oz heavy cream and stevia powder. Heavy cream is fat, so any overnight ketosis (if achieved) should continue into the day uninterrupted.
Lunch, if any, or any other food before supper, will be just protein and fat. Examples include a can of Brisling sardines in EVOO, a can (or 2) of kippered herring in brine, or a hard-boiled egg (or 2). And iced tea sweetened with liquid stevia. Occasionally I will lunch on a can of pork liver pâté. A snack break from gardening can be an iced tea and a few spears of dill pickles to restore lost salt and maintain fluids and electrolytes. Before supper, to accompany a (or 2nd) spritzer, I might indulge in some celery or sliced radishes, with added salt.
Supper on feast days will include a small to medium (not large!) serving of protein, with inherent and added saturated fat, and one low-carb vegetable, prepared with added fat (butter or olive oil), or a salad. Vegetables include green beans, asparagus, cauliflower, and broccoli. My salads include romaine, mushrooms, hazelnut pieces or slivered almonds, and aged grated Parmesan Reggiano tossed in a homemade vinaigrette. My beverage, to wash down the pills: 2 red wine spritzers – 5 to 6 oz of red wine in a glass filled with seltzer.
This regimen works because, even though this is a low-calorie meal plan for a “feast” day, at no point in the day will I be hungry. That’s because my metabolism is humming along in high gear, burning body fat for energy so long as both my blood sugar and blood insulin levels remain low and stable. I eat this food because I like it. I am not hungry before “breakfast,” but I enjoy my morning coffee. And I look forward to a break from working in the garden – to rest and refresh myself, have a beverage and sometimes a bite, and then go back to work.
“FASTING DAYS”: On these days (2 or 3 every week), I will consume about 300kcal/d. I will take my morning pills with the usual 12oz coffee, 1½ oz heavy cream and stevia powder. If I feel dehydrated during the day, I will have just iced tea and a slice (or 3) of pickle; and in the evening, just one red wine spritzer with my pills.
Macronutrients: Coffee w/cream: Fat: 16g (144kcal), Protein: 1.2g (5kcal), Carbs: 1.2g (5kcal); Total: 154kcal. Spritzer (6oz): Carbs: 4.5g (18kcal), Ethyl alcohol: 18g (126kcal); Total: 144kcal. Fasting day total: 298kcal. The secret, I think, for the success of this “feast/fast” regimen, is that since I eat VLC, I am already “keto adapted.”

Sunday, April 23, 2017

Type 2 Diabetes, a Dietary Disease #377: My 10-week, 30-lb Challenge: Final Report

Executive Summary: Primary End Point: Achieved, lost 31 pounds in 10 weeks. Discussion: All day fasting (300kcal/day) – either alternate day or 3-consecutive-day fasting – is an effective way to break a weight loss plateau if you are keto-adapted to start. It is easy because you will not be hungry, and it is effective because you lose weight while your metabolism continues to run in “high gear” as you burn your own body fat. During fasting your fasting blood glucose will fall dramatically (while continuing a Metformin regimen), but not below 60mg/dl. There was no hypoglycemia. Gluconeogenesis from fatty acids and amino acids provided glucose. My FBG average dropped from 119mg/dl before to 81 (10-week average). A1c went from 5.8% to 5.3%. Lipid Panel: Total Cholesterol: 201mg/dl; HDL: 74mg/dl; LDL: 114mg/dl; Triglycerides: 67mg/dl.
Week 6: Lost 0 lbs. Annoying. I thought I might be in trouble when after my first day of fasting this week I had lost only 1 lb and my FGB was 83. The week before my FBG was 61. I also ate out on Friday (3/17), and while lunch was VLC, my supper was 3 Ultras and ad lib peanuts. So, Saturday’s FBG was 107 and my weekly average bumped up to 79 (4.3mmol/L). Still, not bad.
Week 7: Due to the less-than-desired results in Week 6, I decided to try a 3-consecutive-day fast this week (Tue-Wed-Thu). I’m never hungry on fast days, so I thought it would be easy…and it was. No hunger, even on Friday morning. I could have kept it up for longer, easily. I had lots of energy and low but consistent fasting blood sugars (60s & 70s), average 71 mg/dl, and I lost 2 pounds. It was successful so I decided to repeat the 3-day fast the next week.
Week 8: Once again, the 3-day fast was easy. No hunger. Very little thinking about food. When I wasn’t busy with projects, or needed to rest from pushing hard all day, I sat down and read for half an hour. This week I ended the fast with a seminar in NYC that included a talk by Gary Taubes and lunch. I had the salad (with candied walnuts!), a piece of chicken and a spinach side. For supper, I had a petite filet, broccoli rabe side, and a drink. FBG this morning was 87! That raised my weekly average to 74mg/dl. I also lost 5 pounds, bringing my 8-week loss to 25.
Week 9: All good things, as they say…slow down. My weight loss continued, but just 1lb, to 26. My FBG average jumped 15 points, to 89mg/dl (range 74 to 101). Explanation (excuse): I spent most of the week in Florida and on the road. It’s hard to stay on track with so many diversions. I cheated. “No dessert,” I said at the Charleston Grill, but then without thinking ate the offered petit fours. Etc. So, with only 8 days remaining in my 10-week, 30-pound challenge, I will need to employ “the nuclear option” again this week: a 3-consecutive-day fast; still 4 pounds to go.
Week 10: It worked, for the 3rd time. I lost 5 pounds, bringing my 10-week weight loss to 31. And my FBG average was 80mg/dl (4.4mmol/L) – higher than expected, due no doubt to the adjustment period the body needs to down regulate from the previous week’s excesses. The 3-day consecutive fast, I discovered, is just as easy as, and more effective than, the Tuesday-Thursday alternate day fast. You just need to be keto-adapted to avoid hunger altogether.
Conclusion: If you eat VLC (just 15-30 grams of carbs/day), and you are thus keto-adapted, and you reach a weight loss plateau, you can effectively employ full-day fasting (alternate day or consecutive day) to restart weight loss in a healthy way. I did and I lost 31 pounds in 10 weeks.

Sunday, April 16, 2017

Type 2 Diabetes, a Dietary Disease #376: “I have gone off carbohydrates almost entirely.”

A couple of columns back I told the story of a man I had met only once, and then only briefly, at a New Year’s Eve party. I was, shall we say, sort of “juiced”, and probably rattled on a bit about my Way of Eating (WOE). I related how I had lost a lot of weight, and improved many other health parameters, on a Very Low Carb (VLC) diet. I then apparently gave him a card for my website, The Nutrition Debate. I honestly expected nothing to come of it.
A few weeks later he emailed me, “I have gone off carbohydrates almost entirely…and lost 10 pounds.” I replied congratulating him on his success and his motivation. I asked, “What was the trigger for you?” He said, “My doctor had me tested for diabetes and suggested I might be pre-diabetic – hence the urgency for weight loss.” I asked, “Why Very Low Carb?” He had doubts, he said, but “I am hoping I will do myself more good than harm.”
In terms of mental reservation, given the fat phobia most people have learned from bad government guidelines, and from the medical establishment and the media, that was a fair place for him to be; that notwithstanding, however, my casual acquaintance took the next step. In his words, he foreswore “carbohydrates almost entirely.”
THEN, 6 WEEKS LATER I GOT THIS UPDATE: “LOST 40 POUNDS AND AM TAKING ONE-A-DAY ‘SILVER’ DAILY.”
I was thrilled for him and pleased that I had at least been a catalyst. It was just serendipity that I had been there (sort of) at that moment to help him point the gun at the right target, carbohydrates, before pulling the trigger.
My new friend had the 3 keys: 1) the motivation, 2) the courage, and 3) the pertinacity to stay with it. All three are critical, but the “catalyst” for him was my bibulous rant on New Year’s Eve. What’s your trigger?
In my case, in 2002, I had been a diagnosed type 2 diabetic for 16 years and still eating a “balanced” (55-60% carbohydrate) diet as I had been for my whole life. And I had recently gained enough weight that I was too fat to weigh in on the doctor’s scale. So, before a scheduled appointment I stepped on a commercial scale and “discovered” I weighed 375 pounds. I was shocked. That was my motivation. And then serendipity stepped in.
As I opened the door to my doctor’s waiting room, he was standing at the nurse’s station and said, “Dan, have I got a diet for you!!!” Six weeks earlier my doctor had read the New York Times Sunday magazine cover story: Gary Taubes’s ground-breaking, “What If It's All Been a Big Fat Lie.” He tried the diet Taubes promoted. Besides losing 17 pounds in 6 weeks, he liked the effect it had on his lipid profile. So, he suggested that I try it, and I did.
The third factor, your firmness of purpose, or dogged determination, may seem to the uninitiated (or the misled) to be the hardest of the three, but it’s not. After just a few days of adjustment, while you use up your glycogen stores, or immediately if you’re already keto-adapted, it becomes accustomed to eating mostly protein and fat. It no longer craves carbs because your blood insulin level has dropped enough to allow access to your body’s fat stores. It then breaks down body fat when the calories you eat are insufficient to maintain energy balance.
But it can’t do this 1) if you eat enough carbs to raise your blood insulin level and/or 2) you eat more food than you need to maintain energy balance. But you won’t, if you listen to your hunger signals, because when your body is burning its own body fat, you are not hungry. Your body is feeding on its own fat stores, so it doesn’t tell you, “I’m hungry. You must feed me with food-by-mouth.” That’s what makes this easy. You won’t be hungry (after I period of adjustment) because your body is content to feed on its own fat stores. And it makes sufficient essential glucose from amino acids (from digested protein) and from the glycerol molecule freed up when body fat (triglycerides) break down. And in the process it will make ketone bodies, which your brain will love.
So, what’s happening with my new “friend” who lost 40 pounds in two months after “going off carbohydrates almost entirely”? I don’t know, but if he sticks to a Very Low Carbohydrate eating plan, both he and his doctor will be very happy – he a lot healthier and happy with the weight loss and his doctor with his improved lab tests.

Tuesday, April 11, 2017

Type 2 Diabetes, a Dietary Disease #375: A New Year’s Eve Conversation, Part 2 of 2

Part 1 of this 2-part series (#374 here) relates how “Bruce” lost weight easily by “going off carbohydrates almost entirely” for two weeks. I met Bruce casually at a New Year’s Eve party and gave him one of my cards. He decided to check out my website, www.thenutritiondebate.com  and then to try Very Low Carb (VLC) eating. In our earlier conversation that evening, Bruce told me that in those first 2 weeks he had lost 10 pounds. The conversation continues here:
Dateline: January 14th (still later that evening)
You’re welcome, Bruce. Weight loss was my original motivation (in 2002) for eating VLC because, like yours, my doctor thought that being overweight was a cause of T2DMThey were both wrong, as Gary Taubes and many other experts in physiology and medicine have now exhaustively and conclusively proved. See my #5 here or Taubes's "Alternative Hypothesis" in "Good Calories-Bad Calories" (2008), a heavy but solid, evidence-based read.
An easier read would be, "What If It's All Been a Big Fat Lie," the New York Times Sunday magazine cover story of July 7, 2002, here: My doctor read this, tried it himself, and recommended the diet to me. That's when I got interested in low carb for weight loss. And, incidentally, it started the modern revolution in dietary science that so much of the orthodox profession continues to dismiss. That's why Taubes, who won the National Science Writers’ Association award 3 times, wrote GC-BC. Sadly, he was to be disappointed by the medical community’s response. 
Insulin Resistance (IR) is the cause of T2DM. It is also the cause of obesity, not the other way around. Insulin is the transporter of glucose in the bloodstream, and so long as there is enough glucose (from carbs) circulating in the blood, insulin remains elevated and blocks the alternative fuel, body fat, from breaking down to fatty acids to maintain energy balance . The body saves this fat, a more dense source of energy (9kcal/g vs.4 kcal/g for carbs and protein), for long fasts, including famine and winters (from a Paleolithic/historic perspective). I wrote about this in this post: The Nutrition Debate #308, “Introduction to What Causes Type 2 Diabetes,” here.
Since resuming my column a year ago December, my focus has been on "Pre-Diabetics," newly diagnosed Type 2s, and those who, like you, have been told they "might be Pre-Diabetic." The medical societies have been very slow to revise standards for diagnosis, but they have been doing it. They just haven't gone nearly far enough. There are many clinicians today who have, however, and many who just may (I don't know your values, and I'm not an MD) classify you unambiguously as Pre-Diabetic, or even a frank Type 2.
I hope you have a baseline A1c on a recent lab test, because it you stay on your VLC Way of Eating, you will see it drop, perhaps significantly, and perhaps even out of the range of Pre-Diabetic completely to below 5.7%. That should be your goal. "Normal," btw, is between 4% and 5%. Anything above 5% is a sign of Insulin Resistance.
I also hope you have a baseline metabolic panel or at least a lipid panel with which to compare your next lab tests. After doing this Way of Eating for awhile, my HDL more than doubled from 39mg/dl to 84mg/dl (comparing 15 average tests for both). And my triglycerides plummeted by two-thirds (from around 150mg/dl average to below 50 average. Both values have stayed there for many years now. My total cholesterol and LDL cholesterol have been stable and slightly lower. My latest test: TC 184; HDL 91; LDL 84; TG 46.
Google "Metabolic Syndrome." It is the precursor to and the “unifying hypothesis” for all these metabolic disorders. I wrote about it almost 5 years ago in an early column of The Nutrition Debate: Metabolic Syndrome.
Dan
BTW, after one day of eating VLC (a strict version of Low Carb, like Atkins Induction), before losing weight, I had a hypo and called my doctor who told me stop taking one anti-diabetic oral med. The next day he cut the other two in half and soon thereafter in half again, later eliminating the sulfonylurea completely. Now I just take Metformin.
Dateline: February 29th (6 weeks later)
I emailed Bruce to invite him to another party, our annual Winter Wing-Ding. He replied:
Hi Dan,
Thanks much for the invitation, but I am in Jensen Beach for January only.
Lost 40 pounds [my emphasis] and am taking One-a-Day “Silver” daily.

Bruce