Friday, December 23, 2016

Type 2 Diabetes, a Dietary Disease #360: Ten years ago, I had a relapse (Part 5)

As readers following this series know, I decided to write it after I stumbled on an old misfiled Excel folder detailing my early “carb counting” days from 14 years ago. After regaining 12 pounds of 60 that I had lost on Atkins Induction in 2002, in 2006 I rededicated myself to Dr. Richard K. Bernstein’s 6-12-12 plan for diabetics. Fifty weeks later, with strict adherence and record keeping, I had lost another 96 pounds. When added to the previous 48 (60 – 12), my loss then totaled 144. I would eventually go on to lose a total of 170 pounds.
In the beginning I still ate a lot, but I did not limit calories, fat or protein. Just carbs. I had a much larger body to feed then and therefore a lot more organism (and psyche) to satisfy. A person who is used to eating, and receives gratification from eating a lot, needs to acclimate him/herself to this new lifestyle. You need to make a gradual adjustment to smaller meals. And you need to shift gratification from a feeling of being full to a feeling of liking that “lean” feeling and seeing the weight loss as recorded every day and every week.
What surprised me (and amazingly my doctor as well), was how, from Day 1 on strict Atkins Induction, the very low number of carb grams had an immediate effect on my blood sugar readings and on my medications. On Day 1 I had a hypoglycemic episode, and several more that first week. My doctor immediately dropped the 3rd oral anti-diabetic med he had recently started me on and then in successive days that first week, recognizing that I was overmedicated, cut the other two meds, on which I was maxed out, in half twice. In just one week, before weight loss was even noted, I had reduced my diabetes medications by 90% (8/9ths).
When I started on Bernstein in October 2006, I was still on 5mg Micronase (glyburide, a sulphonylurea or SU) and 500mg of Metformin. I only kept a record of estimated carb grams, and took 4 took blood sugar readings a day: Fasting, 2 hr postprandial, late afternoon (before Happy Hour) and 2 hours after supper. I would later add protein, fat, and calories to my records. Still later I added saturated fat, cholesterol, sodium, fiber and simple sugars (mono and disaccharides, added and naturally occurring). Total sugars were always VERY low.
I kept records in 4-week tables. My goal was simply 30 grams of carbohydrate a day, ala Bernstein’s program.My first 4-week average carb count was 33 grams a day, range 16 to 59, but those were outliers. Most were 20s and 30s. The interesting thing about this month was my blood tests. The fasting average the first week was 139mg/dl. It dropped in weeks 2, 3 and 4 to 107, 104 and 104. But the really interesting result was my late afternoon blood glucose readings. The first week’s average was 85mg/dl. The second week’s was 78, but by the 3rd and 4th weeks it had dropped to 59 and 56, with 6 out of 7 readings in the last 2 weeks in the 40s.
On only 5mg of a SU, while eating VERY LOW CARB, I WAS OVERMEDICATED! So, in the next 4-week period I stopped the SU for 2 weeks and then added it back at a reduced dose of 2½mg. My late afternoon averages were now 95 and 114mg/dl for the weeks without an SU, and 57 and 81 for the weeks at the reduced dose. My carb gram average for this 4 week period was 31, down from 33, and very close to my goal of 30.
Not bad, considering this period included Thanksgiving… and Christmas was coming. Oh, by the way, I also lost weight during these successive 4-week periods: 10 pounds the 1st, 14 the 2nd, only 1 the 3rd (including a 150 carb binge on Christmas Eve and on Christmas Day another 94g carb binge). These and a few more seasonal indulgences bumped the December carb gram average up to 51 grams a day. And my weekly fasting sugar averages increased as well in December (105, 109, 111 & 112), but my late afternoon weekly averages held sort of steady (72, 77, 83 & 95) and my evening 2-hr postprandial averages were fine (87, 87, 83 & 95).
In January, I got back to eating according to plan, and my carb gram average dropped to 32 grams a day. Increasingly, however, my late afternoon readings were again dropping below normal (70-100mg/dl), with weekly averages going from 85 to 71 to 67 to 68. So, in the next 4-week period, my average daily carbs dropped to 23! I took no glyburide in week 3, and starting in week 4 I split the tiny pill in half and took just 1.25mg/day. My late afternoon blood glucose average went from 72 to 77 to 95 and back to 87mg/dl.
On March 17, 2007 (end of week 23 on Bernstein 6-12-12), I stopped the sulphonylurea altogether. SU’s are bad news. They effectively lower your blood sugars but at a very big price. They beat up and deplete the pancreas of beta cells and impair its ability to make insulin. Eventually you must inject insulin as your body loses its ability to produce it. 

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