The Nutrition Debate #134: “You Really Don’t Need to Test”

“You really don’t need to test,” my new doctor, an internist and cardiologist (and PHD!), told me recently as I was leaving his office. It was only my second visit, and it was at my suggestion that I will see him 3 times a year instead of once, so I think it was a nice gesture on his part to give me assurances and comfort that my health in general, and in particular my type 2 diabetes and hypertension, were “under control.”

He was also telling me that my other labs, specifically my A1c, blood pressure, and Lipid Panel, all suggested – to him – that the therapeutic regimens that his predecessor had ordered and he was continuing, had me in good shape. I got the impression that seeing me, for him, was a bit of a relief – that most of the patients he saw on a daily basis were truly sick people. I was “healthy,” by comparison, and that made his time with me easier for him. He almost seemed, to me, to be having fun! I liked that. It made me feel good too.

But here’s the rub. He was telling me that my condition didn’t warrant the level of blood glucose testing that I had requested he prescribe for me: two times a day. His rationale was that my A1c, at 5.6% at the time, as it was less than 5.7%, was regarded as a value consistent with an “Decreased Risk of Diabetes.” This “Reference Range,” the Quest Diagnostics lab report said, was “supported by the current ‘Standards of Medical Care in Diabetes’ published in January of the current year in Diabetes Care, the Journal of the American Diabetes Association.” So, that’s that. He was ‘covered’ because the ADA says that I am at decreased risk of diabetes, so ipso facto daily testing was not warranted. For the new reader, and to remind regulars (and my doctor), I have been a full-blown, diagnosed type 2 diabetic for 27 years.

Never mind that the report generated by the blood drawn at that consult showed an increase in my A1c to 5.8%, which is considered consistent with an “Increased Risk of Diabetes.” But elsewhere in this same report, based on the results of a VAP (TM) Cholesterol Test that I requested, Quest advised, in response to the question, should the physician “CONSIDER INSULIN RESIST/METABOLIC SYNDROME,” the response was a flat “NO.” Never mind that I AM today insulin resistant and, before I changed my diet, had ALL of the indications of Metabolic Syndrome. See “The Nutrition Debate #9” for a complete list of the indications and ranges if you would like to see if YOU have an undiagnosed case of Metabolic Syndrome.

So, how can all of these seeming paradoxes coexist? Why is it that my diabetes is no longer discoverable by a lab test or a clinician’s interpretation? They would be, of course, with a full medical history, but my new doctor is only acquiring that as he gets to know me. A good sign: he offered to be added to the email distribution of my twice-weekly diabetes blog. How cool is that! My previous (now deceased) doctor also was on the list and occasionally emailed me with comments.

 Anyway, I digress. My reason for writing this post is to make the point that the patient who has taken control of his diabetes health care, and treats it almost entirely with diet alone, can achieve these results EVEN IF HE OR SHE IS INSULIN RESISTANT. When you eat very few carbohydrates, your blood insulin level goes down, and your insulin sensitivity goes up. Insulin sensitivity is the inverse of insulin resistance. And importantly, your blood glucose stabilizes.

A few months ago I asked an endo in Florida to do a HOMA Assessment to determine my beta cell function and insulin sensitivity. The results surprised me, since I had been maxed out on a sulfonylurea for the better part of 20 years. Beta Cell Function: 68.2%. Sensitivity: 94.6% and IR 1.1 (1.057). I attribute these “good” results to my Very Low Carb diet.

And when you achieve these results through strictly eating Very Low Carb, YOUR TYPE 2 DIABETES WILL BE IN REMISSION. The lab can’t tell that you’re a full-blown type 2 diabetic. Neither can your doctor, if he doesn’t know your history. But that doesn’t mean you can rely on the assurances that you’re in “good control” just because you are well below the thresholds of the American Diabetes Association for being “Consistent with Diabetes (> or = 6.5). You don’t want to be there. You don’t want your type 2 diabetes to be a PROGRESSIVE DISEASE, as the ADA defines it. And by extension your physician will too, if he/she follows the “Standards of Medical Care in Diabetes, as most will likely do.

YOU can treat yourself through diet, and the best way to do that is to learn about the carb content of the foods you eat and how your metabolism handles them. And the only way to do that is to test.  Test before and 1-hour after a suspect meal. Adjust the menu to meet your goals. Test in the morning before eating (fasting blood glucose). Test to keep yourself honest - to remind yourself that you are diabetic and will always be carbohydrate intolerant. You cannot cure this disease. You can only treat it. And the absolute best way to treat it is with diet. Vigilance is required. And some discipline. But the food choices are endless, and very good. As your body adapts to using ketones, you will have increased physical energy. (See the next column.) You will feel better. And if you need to lose weight, you can do so easily (with calorie restriction) and without hunger. What more can you ask? 

 

What did your meter tell you today?