Okay, this is going to be an opinion
piece. I admit to bias, but I will strive to present the subject in a factual
way. That being said, I am not a doctor. I am a Type 2 diabetic with 33 years
of experience, all of which gives me certain bona fides (and contributes to my bias). In fact, the revelation
that my pharmacist was an insulin-dependent Type 2, and died prematurely, was
the impetus for “The Nutrition Debate.” His death was a totally unnecessary
tragedy.
First, a little background. There are
two types of diabetes: Type 1 and Type 2. Type 1 is an autoimmune disease. The onset
usually occurs in childhood, permanently destroying the body’s ability to make
insulin, a key hormone produced by the pancreas. Until the discovery of man-made
insulin in 1922, most Type 1s didn’t live long. The only medical treatment was
a strict medical “ketogenic diet” in which the patient’s dietary intake (food)
was 90%+ fat.
Type 2 diabetes, formerly called
“adult onset diabetes” but now found in children, is a disorder of metabolic
disregulation resulting from insulin-resistance at the cellular level. The
pancreas thus overworks to produce insulin. It is diagnosed by testing blood
glucose since one of insulin’s key duties is the transport of glucose, the
molecules that originate in food as complex carbohydrates and simple sugars. If
the cells are resistant to insulin, glucose doesn’t get taken up into the cells
and the level of glucose in the blood rises. The diagnosis of Type 2 diabetes
is made with an elevated fasting blood glucose (on 2 consecutive office
visits), or preferably one elevated hemoglobin A1c test, reflecting a 3-month
average of circulating glucose as measured on the surface of red blood cells.
Type 2 diabetes is often suspected in
overweight and obese individuals. Why? Because insulin stores fat. When we consume carbohydrates, the body
chooses wisely to use the sugars and starches in foods (that all
convert to glucose) as its primary energy source. It conserves body fat for use
when food is not available. It’s a brilliant design, since fat is a very good
storage vehicle. It is more than twice as dense in energy (9 calories per gram
vs. 4 for carbs).
When a doctor determines a patient is
a Type 2 diabetic, the conventional medical treatment is to 1) council weight loss
via “diet and exercise,” and/or 2) prescribe an oral medication to help. If the
patient is not successful in losing weight, the doctor adds another oral med
and then maybe a 3rd med to the “cocktail.” More recently, new injectable
medications (GLP-1s) are sometimes prescribed. Insulin injections are usually
reserved as a “last resort.”.
Many patients who are treated using
the ADA’s standards for blood glucose control, which are much too lax, will eventually progress to becoming insulin-dependent
Type 2s. The medical community acknowledges this. They consider Type
2 diabetes a progressive disease, with a decrease of 10 years in the
expected lifespan for T2 adults and 15 years for T2 children, compared to
non-diabetics. In reality, however, Type 2 diabetes is a dietary
disease.
Normalized glucose control is
essential to reduce the complications of long-term elevated blood glucose
levels: peripheral neuropathy (nerve and microvascular damage), commonly resulting
in amputations; retinopathy (damage to the blood vessels of the retina,
resulting in blindness); and nephropathy (end-stage kidney disease).
Insulin therapy for Type 2 diabetics
usually begins with “basal” insulin, injected once a day. To this is added
“meal time” insulin in which you, the patient, estimate the amount of
carbohydrate you will eat at a meal and then inject an appropriate dose 20
minutes or so before each meal. Some people now wear an “insulin pump” in which
a needle, embedded under the skin, injects an amount that you determine by
making an adjustment on the pump.
If
you are a Type 2 diabetic, what does this
suggest to you? If your pancreas still makes insulin, couldn’t you
do the same? 1) Eat only small amounts of carbohydrates and thus only need to
use small amounts of the body’s precious supply of insulin? And 2) Avoid
glucose spikes, and thus protect your pancreas from further damage. I think you can! Remember:
Type 2 diabetes is a DIETARY disease, and YOU control what
you eat!
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