Type 2 Diabetes, a Dietary Disease #332: “Pre-Diabetic” or un-diagnosed Type 2?

I recently talked for an hour or so to a friend who knows that I know a lot about Type 2 Diabetes. He sought me out to ask me what he should do. I asked him, “What is your situation?” Here’s what he told me:

His fasting blood sugars (FBG), he said, are consistently running in the 140s. That’s 140mg/dl. I told him that was “out of control.” I asked him what his postprandials were. He didn’t know “postprandial” so I said your blood sugar 1 or 2 hours after starting breakfast. He said he didn’t know. He didn’t do postprandials.

I asked him what his latest A1c was. He replied 6.9. That’s 6.9%, but he said it was almost 2 years ago. I asked him if his doctor had told him that he was diabetic. He said “No,” and I said, “Well, you are!” The American College of Endocrinologists define Type 2 Diabetes as an A1c of ≥6.5%, and the American Diabetes Association as ≥7.0%, but that definition is part of the problem. Some clinicians today regard an A1c of ≥5.7% as full-blown Type 2 diabetes.

I asked my friend if he was currently taking any medications to control his blood sugar. He said, “Yes.” He was taking two 500 mg tablets of metformin twice a day, plus glyburide (a sulfonylurea). He didn’t remember how much, and I don’t remember how often he takes it, because this set me off on a rant.

I said, “You are already maxed out on metformin” at 2000 mg/day, and you are taking a sulfonylurea (SU), a class of medications that pumps the pancreas to produce insulin to cover the carbs you are eating, AND IT’S NOT ENOUGH!” SUs ARE A DRUG THAT, WHILE STILL PRESCRIBED BY UNKNOWING PHYSICIANS (BECAUSE ITS CHEAP AND “EFFECTIVE” IN REGULATING BLOOD SUGAR BY SECRETING INSULIN), BEAT UP AND WEAR OUT THE BETA CELLS IN THE PANCREAS THAT MAKE THE INSULIN, AND THEY EVENTUALLY DIE!!! RESULT: YOU WILL SOON BE TAKING BOTH LONG ACTING AND MEALTIME INSULIN (INJECTING IT) TO CONTROL YOUR BLOOD SUGAR.

He said, “What should I do?” I didn’t hesitate to tell him: “You’ve got to change what you eat, I mean seriously change what you eat.” “What do you have for breakfast,” I asked? “Oatmeal,” he said, “with milk and a little sugar.” “Switch to eggs,” I said, “any way (fried, scrambled, poached).” “How many”, he asked? “One, two or three; add a strip of bacon if you like,” I said, “but no juice, cereal, bread or jelly. Only heavy cream and artificial sweetener in your coffee, if you must.” I told him he wouldn’t be hungry. He wouldn’t need a mid-morning snack. (He had mentioned he ate an apple in mid-morning “’cause he was starving.” I just rolled my eyes in horror.)

I also told my friend that he had to get off the SU. But the effect could be that his A1c will go up unless he instead replaces it with a drug that acts in a different way, sparing the pancreas. There are now several more modern classes of drugs, both oral and injectable (not insulin). Many clinicians would even argue reasonably that a temporary course of exogenous insulin would perhaps be the best course of treatment in his case to get his blood sugar under “good control.” But I would argue that the best course of “treatment,” and the only one that addresses the cause of Type 2 Diabetes (which is Insulin Resistance), is to radically change what you eat, NOW.

My own experience supports this course of action. In 2002 I weighed 375 pounds and I was maxed out on metformin and a sulfonylurea and starting a DPP-4 inhibitor (Avandia). In retrospect, I was on my way to injecting insulin. My doctor wanted me to lose weight, of course, so he “prescribed” a radical change of diet, a Very Low Carb diet called Atkins Induction. The surprising result was that on the 1^st day of strict compliance I got a hypo (a low blood sugar). The doc ordered me to stop the Avandia. The next day, another hypo, and he told me to cut the metformin and the glyburide (the SU) in half. A few days later I had to cut them in half again. Still later I cut out the SU altogether. Eventually, I transitioned to Dr. Richard K Bernstein’s 6-12-12 program for diabetics.

After a few years or eating this entirely different way, I had lost 170 pounds, my blood pressure was 110/70 (on the same meds), my HDL-C more than doubled and my triglycerides dropped by 2/3rds. And all I did was change what I ate.