The Nutrition Debate #306: My New Manifesto: “Type 2 Diabetes, a Dietary Disease”

You may have noticed I took some time off for R & R.  The 305 archived columns, however, saw frequent visits.

The hiatus gave me an opportunity for introspection. It enabled me to re-examine my purposes and the best methods of achieving them. As my visitors know, I d­­o this for eleemosynary purposes. I have no pecuniary interest: no advertising, no dietary supplements to sell, no book to promote; there’s nothing in it for me. I do this, with the help of a great volunteer editor, for purely educational purposes.

As I said in The Nutrition Debate #114, “My Insulin Dependent Type 2 Pharmacist,” I started writing this column because a friend in my community – who was a registered pharmacist – died, unnecessarily and tragically. He was a Type 2 Diabetic. In 1986 when I was first diagnosed a Type 2, he helped me pick out my first blood glucose meter, and he filled my first prescription for an oral anti-diabetic medication.

That’s when my pharmacist told me that he was an insulin-dependent Type 2. He followed his doctor’s orders – and the advice our government has dispensed for half a century – and his disease progressed to its inevitable conclusion. His death was a waste. It didn’t need to happen that way. And that’s my motivation and my message.

With that in mind I have decided to focus my efforts on a large underserved segment of the diabetic population.  I want to explore an aspect of Type 2 Diabetes care that is little understood and generally ignored by the medical and pharmaceutical communities: the self-management of Type 2 Diabetes by the patient and how best to do it.

I am especially interested in reaching what the medical community calls the “treatment-naive” patient, that is, someone who is newly diagnosed (as Pre-Diabetic or Type 2 Diabetic) and has never been subject to any “treatment.” Such patients are at a critical juncture, and denial is an extremely tempting option. Typically, the patient just defaults into a dependent state and accepts their doctor’s ministrations (as we usually do in healthcare matters). However, a diagnosis of Pre-Diabetes or Type 2 Diabetes is actually a great time to look into what this disease is really all about and learn what you, the patient, can do about it. As a well informed patient, you can self-manage your diabetes care under your doctor’s watchful eye and “supervision”? 

Self-management of Type 2 Diabetes is a mutually beneficial arrangement. Doctor’s know that Type 2 Diabetes is largely a patient managed disease. They call it “patient-oriented” care, but that still leaves the impression that patient care is a collaboration that the doctor manages. I’m sorry, but as far as dispensing dietary advice is concerned, most doctors and conventionally educated and certified Registered Dieticians aren’t qualified to manage the care of Type 2 diabetics. So, in the days, weeks and months between doctor’s appointments, you will manage your diabetes care, and at the office visit your doctor will order tests and monitor (not manage) your improvement. Alternatively, if you default to medical management, after initially getting your blood sugar under control with drugs, your doctor will simply manage, and record, the progressive worsening of your condition.

You, the patient, know full well that “doctor’s orders” to “try hard to diet, exercise and lose weight,” aren’t easy to follow and aren’t enough. You’ve seen friends and relatives struggle. Something must be wrong with the “prescription,” you’re thinking. The doctor knows it too, but the only arrow in the quiver of the otherwise uninformed or, sadly, misinformed clinician is, “More medications could be used.” That’s the road my poor pharmacist took, and look what it got him – progressively worsening disease… and then a slow, premature death.

Therefore, the new focus of “The Nutrition Debate” will be “Type 2 Diabetes: A Dietary Disease.” It will begin with this post (#306) by the eponymous title. Then, the next posts will be #307, “Preface, A Personal Story (n = 1),” and then #308, “An Introduction to What Causes Type 2 Diabetes.” The first is my bona fides – my “credentials,” as it were. The second post is an overview of the science, as I see it. These will be followed by #309, “Type 2 Diabetes Q & A: 20 Brief Vignettes,” each fewer than 150 words (4-pages total) in Q & A format.

Further posts will return to the manifesto that drives this new focus: that Type 2 Diabetes is a Dietary Disease. I welcome comments and “debate.” After all, I have taken a very strong position which, as I see it, is irrefutable. Of course, although I consider myself “informed,” mine is just “A Personal Story: n = 1,” and “Your Mileage May Vary (YMMV).”  But, if you read “An Introduction to What Causes Type 2 Diabetes,” it’s difficult for me to see how anyone could look at Type 2 Diabetes in any way other than that Type 2 Diabetes is a Dietary Disease.”