Type 2 Nutrition #401: “Improve your A1c with a non-insulin option”

Have you seen this diabetes drug commercial on TV? It always makes me laugh. I’ve been a diagnosed type 2 for 31 years, and my last A1c was 5.2%. That was a big improvement from 5.8% eight months ago. The only diabetes medication I took eight months ago and I take now is Metformin. I improved my A1c with another “non-insulin option.” I control my diabetes with Metformin, and I improved my A1c by eating Very Low Carb.

Of course, the TV ad had a different “fix” in mind for you. It was playing on the dread people have for the drudgery of daily insulin injections. Most insulin-dependent type 2s inject a slow-acting basal dose of insulin once a day and then many (most?) inject a fast-acting bolus with each meal. Thus, with this 1 to 4 injections-a-day routine, if you are very careful to avoid hypos, you can achieve “good” blood glucose control. It’s an onerous path to follow.

It doesn’t have to be this way. I weighed over 300 pounds in 1986 when an internist diagnosed me as a type 2 with a high fasting blood sugar (FBS). He started me on an oral anti-diabetic drug of the only class then available in the U.S., a sulfonylurea. Seven years later an endo gave me my first A1c test. It was 8.9%. My FBS was 197. Nine years later (2002) I was maxed out on both the sulfonylurea and Metformin and had started on Avandia.  My FBS was 81, so my doctor had my “progressive” diabetes under control with drugs. But we both knew that when the 3^rd class of drugs was no longer effective, I would “graduate” to insulin. I weighed 375 lbs.

So, my doctor now turned his attention to my weight again. He had tried before. I had seen his staff dietician who advocated a “restricted-calorie, balanced diet and exercise.” It didn’t work. I lost weight but promptly regained it. Then, in July 2002 my doc read the New York Times Sunday Magazine cover story, “What If It's All Been a Big Fat Lie,” by the science writer Gary Taubes. He tried the diet described himself, and it worked. When he came back from vacation in September, he asked me to try it too. He wanted to monitor me closely.

The diet was Atkins Induction, which is VERY low carb, just 20 grams a day. On the first day I had a hypo. I called him, and he told me to stop taking Avandia. The next day I had another hypo and he told me to cut the other two drugs in half.  Later that week, when I had yet another hypo, he told me to cut them in half again. So, in just one week, by strictly following a VERY LOW CARB diet, before losing more than a few pounds of water weight, I had dramatically reduced my diabetes meds. My type 2 diabetes had gone into remission.

A year later, in August 2003, I had lost 60 pounds and my A1c was 5.4%. A few years after that, I regained 12 pounds over the summer, so I started on Richard K. Bernstein’s 6-12-12 program for diabetics (30 carb grams a day). Over the course of a year or so, I lost that 12 and another 110 pounds, reaching 205 pounds at the end of 2008. That was my weight when I completed Army Basic Training in 1960! And my A1c was still 5.4%.

Now, 15 years after beginning to eat Very Low Carb, and plenty of “misadventures” (“cheats” with ups and downs), I celebrate by dropping below 200 pounds (186 last week) for the first time since I was in my teens. And although 15 years ago, in 2002, my doctor’s motivation was to get me to lose weight, NOT to treat my so-called “progressive” type 2 diabetes, I have “improved my A1c with a non-insulin option.” Furthermore, I have forevermore avoided progressing to becoming an insulin-dependent type 2. AND MY LATEST A1C WAS 5.2%.

To his credit, although he suggested it to help me lose weight back in 2002, my doctor did have an inkling that eating VERY LOW CARB might help my type 2 diabetes. He said, as he walked me down the hall to schedule my next appointment, “Dan, this diet might help your diabetes too.” Boy, was that an understatement!

Would that more doctors had a similar understanding of the basic relationship between dietary carbohydrates and blood sugar regulation. Type 2 diabetes is, after all, a dietary disease, and the best treatment is self-management by carbohydrate restriction. Your doctor can’t write a prescription for that, BUT YOU CAN!