Sunday, June 30, 2019

Retrospective #134: “You Really Don’t Need to Test”

“You really don’t need to test,” my new doctor, an internist and cardiologist, told me as I was leaving his office. It was only my second visit, and it was at my suggestion that I will see him 3 times a year instead of once, as he suggested. So, I think it was a nice gesture on his part to give me assurances and comfort that my health in general, and in particular my Type 2 diabetes, was “under control,” as conventionally defined by the medical community.
He was also telling me that my other labs, specifically my A1c, blood pressure, Lipid (cholesterol) Panel, thyroid, kidney and inflammation markers, all suggested – to him – that the therapeutic regimens that his predecessor had ordered and that he was continuing, had me in good shape. I got the impression that seeing me, for him, was something of a relief – that I was healthy compared to most of the patients he saw on a daily basis. That made his time with me easier for him. He seemed to be having fun! I liked that. It made me feel good too.
But here’s the rub: He was telling me that my condition didn’t warrant the level of blood glucose testing that I had requested he prescribe: two times a day. His rationale was that my A1c, 5.6%, was considered “non-diabetic,” as it was less than 5.7%. The Quest report describes it as a value consistent with an “Decreased Risk of Diabetes.” This “Reference Range,” the report said, was “supported by the current Standards of Medical Care in Diabetes.”
So, that’s that. He was ‘covered’ because the ADA said that I am at “decreased risk of [incipient] diabetes,” so ipso facto daily testing was not warranted. For new readers I had been, at that time, a Type 2 diabetic for 27 years.
So, how can this seeming paradox exist? Why is it that my diabetes is no longer discoverable by a lab test or a clinician’s interpretation? With a full medical history, of course, it would be, but my new doctor is just getting to know me. A good sign: he wanted to be added to the email distribution of The Nutrition Debate. How cool is that! My previous (now deceased) doctor also was on the list and occasionally emailed me with comments.
Anyway, I digress. My reason for writing this post is to make the point that the patient who has taken control of his Type 2 diabetes health care, and treats it (almost entirely) by diet alone, can achieve these results EVEN IF HE OR SHE IS INSULIN RESISTANT. When you eat very few carbohydrates, your blood insulin level goes down, and your insulin sensitivity goes up. And importantly, your blood glucose stabilizes in the “non-diabetic” range.
And when you achieve these results through strictly eating Very Low Carb, YOUR TYPE 2 DIABETES WILL BE IN REMISSION. The lab report can’t tell that you’re a full-blown Type 2 diabetic. Neither can your doctor, if he doesn’t know your history. But that doesn’t mean you can rely on the assurances that you’re in “good control” just because you are well below the thresholds of the American Diabetes Association. YOU DON’T WANT TO BE THERE. You don’t want your Type 2 diabetes to be a PROGRESSIVE DISEASE, as the ADA defines it. And as your physician will too, if he/she follows the “Standards of Medical Care” in Diabetes, as he or she most will almost certainly do.
YOU can treat YOURSELF through diet. The best way to do that is to learn about the carb content of the foods you eat and how your metabolism handles them. And the only way to do that is to TEST.  Test before and 1-hour after a suspect meal. Adjust the menu to meet your goals. Test in the morning before eating (fasting blood glucose). Test to keep yourself honest – to remind yourself that you are a Type 2 diabetic AND WILL ALWAYS BE CARBOHYDRATE INTOLERANT. You cannot cure this disease. You can only treat it to put it IN REMISSION. And the ONLY way to do that is with diet. Vigilance and discipline are required. But the food choices are endless, and very good. As your body adapts to using ketones, you will have increased physical energy. You will feel better. And if you need to lose weight, you can do it easily and without hunger.  How do you like them apples? 

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