If an A1c of ≥6.5% is defined as diabetic, and the goal of the American Diabetes Association (ADA) is to manage your blood sugar such that it does not exceed 7.0%, then it follows ipso facto that the ADA’s guideline to MDs is to maintain you, if you are a type 2 diabetic, in a perpetual disease state. What do you think about that?
Two explanations are possible. I’m not so cynical that I would buy into the easy one: that your doctor, and the health care world that comprises about 1/6th of the entire U. S. economy, needs to keep you sick for them to prosper. I understand why it’s easy to go there, but I really don’t think there is such a sinister conspiracy. There has to be another, probably much more complex and difficult, explanation for this conundrum.
The other explanation for the low expectation (≤7.0%) of the healthcare community is that, in their clinical experience, it is difficult under the terms of the ADA’s Standards of Medical Care to achieve the “reasonable goal” of an A1c of ≤7.0%, even with all the pharmaceutical options, both oral and injected, that are and come on the market. Big Pharma has expended vast resources over the last half century to manage type 2s health.
Insulin, discovered in 1921, can achieve that goal, but most patients do not want to inject themselves multiple times a day while monitoring and counting everything they eat to maintain “tight control.” Besides, the ADA and most clinicians do not advocate or practice it because there are serious dangers in some situations (coma and death).They are content to let their diabetic patients remain in a perpetual disease state rather than risk having them pass out and be transported to the hospital with life threatening hypoglycemia or ketoacidosis.
The confounding and mitigating factors for the terms of the ADA’s “Standards of Medical Care” include the American Heart Association (AHA), starting in the 50s, and the U.S. public health establishment, including foremost, beginning in 1977, Government Dictocrats. In that year the Senate Select Committee on Nutrition and Human Needs, aka “the McGovern Commission” produced the “Dietary Goals for the United States.”
Starting in 1980 it was followed every 5 years by the “Dietary Guidelines for Americans” to “govern” what we eat. We followed it, the food manufacturers followed it, and so did the media and medical associations. We ate low fat, low cholesterol, low salt, lean meats, and low-fat cheese and yogurt. A mostly plant based diet.
Simultaneously starting in 1980, we got sicker and fatter and started to develop insulin resistance and type 2 diabetes at increasing rates. A little of this reflects an aging population, but this cannot explain the soaring rates of childhood diabetes. And just look around you on the street, or maybe in a mirror.
The “ship of State,” however, has begun to change course. In 2015 the Guidelines dropped the limit (30%) on total fat and the limit on dietary cholesterol (300mg/day). Eggs and butter, even bacon, are healthy again. Margarine, made from partially hydrogenated vegetable oils (trans fats) is taboo.
But these little known changes, while really significant – seminal, really – are in themselves not sufficient for the type 2 diabetic to reverse his or her disease state and achieve an A1c of less than 6.5% much less the 5.7%, threshold for a diagnosis of pre-diabetes. To reach this goal, or lower, the pre-diabetic needs to change the foods they eat. They need to limit carbohydrates, and not eat the same, one-size-fits-all diet that the government still insists everyone should eat. They need to follow a Low-carb, High-fat (LCHF) Way of Eating.When you start to eat Low Carb, you will feel better. You blood sugar will stabilize. You will feel less tired and less hungry. You will lose weight. And your A1c will come down. I’ve been a diagnosed type 2 for 31 years and have been eating LCHF for 15. On LCHF I’ve lost 180 pounds and my A1c has gone from 8.9% to 5.2%. With no CVD. It’s still a challenge, but if I hadn’t made this lifestyle change, I wouldn’t be here today to write about it.