Type 2 Nutrition #407: Am I non-diabetic now?

Am I non-diabetic now? Seriously. Apparently there’s some disagreement about this. As I said in Type 2 Nutrition #439, a clinician told me that, 31 years after I was diagnosed (later with an 8.9% A1c), and after 15 years of eating Very Low Carb (VLC), with a 5.2% A1c now, I am no longer diabetic. I disagreed. I said that though my Insulin Sensitivity has improved, I am still Insulin Resistant and therefore Carbohydrate Intolerant. I said that I keep my Type 2 Diabetes in remission by restricting carbohydrates (VLC with Intermittent Fasting).

Then, a few weeks ago Megan Ramos, the Director of Jason Fung’s Intensive Dietary Management program, in an emotional rant on Facebook, said that “there are a lot of ‘haters’ out there” who say that, with an A1c of ≈4.5%, she is “not really non-diabetic anymore”; “[She’s] just controlling [her] diabetes with diet.” “Haters”? Huh? Well, isn’t that how she is controlling her diabetes?  Or does she think she is “cured”? In my case, I know that I am NOT cured. If I ate a lot of carbs again, my A1c would skyrocket!!! My guess is that hers would too, regardless of the fact that she doesn’t want to and never will eat that way again (i.e., “pasta 5 nights a week”).

Apparently, people who tell her that she is “just controlling her diabetes with diet” have hit a raw nerve…so I won’t tell her, but I am not a “hater.” I just prefer to look at my condition as one that I need to manage. And it is difficult to manage a condition if I am in denial that I have it. But, I’m willing to take a fresh look at the subject. Am I “non-diabetic” if a doctor who takes my blood (and doesn’t take a history) sees that my A1c is 5.2%? (In my case, besides my Way of Eating, I am also taking 1500mg of Metformin to suppress unwanted glucose production and improve insulin sensitivity, but this does NOT account for my “non-diabetic” A1c.)

So, with respect to my own condition, the matter comes down to whether I take a physiological or a psychological view. I cannot speak to Megan’s approach, nor can I address it from a medical POV; I am not a doctor. Neither am I an insurance underwriter who might take into account my history in setting a life insurance premium. Is it possible, from a life insurance underwriter’s POV, to at one time have been a diagnosed type 2 and then, later in life, to no longer be a diagnosed type 2 diabetic?

Age at onset of diabetes is doubtless a factor too. Incipient type 2 diabetes is undoubtedly more treatable and less intractable at an early age as less beta cell function has been lost. Megan notes that she was diagnosed at age 27 and fortunately found the right treatment immediately. Under Dr. Fung’s direction, she began to eat VLC and incorporated fasting from the get go. In 6 months, she lost 60 pounds and her A1c dropped to 4.5%. Today at 33, Megan takes no diabetic meds that I am aware of, eats LCHF and with fasting is 80 pounds lighter.

I was diagnosed at age 45 but continued to eat a Standard American Diet (neither my doctor nor I knew any better) for the next 16 years. I continued to gain weight and my type 2 diabetes got “worser and worser.” In 2002 I was maxed out on a sulfonylurea (Glyburide) and Metformin and starting on Avandia, a TZD. I weighed 375 pounds. Then, my doctor read Gary Taubes’s “What If It's All Been a Big Fat Lie,” in the New York Times Sunday Magazine (July 7, 2002) and suggested I try the diet described (20g of carbs a day) to lose weight!!!.

Today, 15 years later, thanks largely to eating Very Low Carb, I weigh 190. A little over a year ago, thanks to a suggestion from Megan Ramos, I began full-day fasting. I started with alternate day, then 2-consecutive day and now 3-day 300kcal fasts almost every week. I maintain my 185 pound weight loss by accepting that I have intractable Insulin Resistance and will therefore be Carbohydrate Intolerant for life. As such, while I am now clinically “non-diabetic,” and like Megan intend to stay that way for life, I know that if I ate the way I did before, I would quickly be a “clinical type 2 diabetic” again. Therefore, as a realist I have to say my type 2 diabetes is NOT cured; instead, my type 2 diabetes is IN REMISSION, and that “I control my diabetes with diet.” I will live happily and healthily and hope to remain that way for so long as I accept that reality.